Hepatic lymphoma: an imaging approach with emphasis on image-guided needle biopsy

Involvement of the liver by lymphoma is almost always secondary. A definite diagnosis can be made only after histologic examination. Recently there has been a trend to replace surgical biopsies with percutaneous core-needle biopsies for the diagnosis of lymphoproliferative disorders.

To describe our experience with percutaneous image-guided needle biopsies of the liver in 15 cases of primary and secondary hepatic lymphoma.

Between 1997 and 2002, 15 of all the percutaneous computerized tomography-guided core-needle liver biopsies performed at our institution yielded the diagnosis of lymphoma. We retrospectively reviewed the medical records of these patients.

Seven patients had primary hepatic lymphoma (all non-Hodgkin's lymphoma) and eight had secondary (three Hodgkin's disease and five non-Hodgkin's lymphoma). No major complications were caused by the percutaneous biopsies, and all biopsies were diagnostic. The imaging findings were non-specific but were characteristic and similar to previously described series. Imaging demonstrated hypodense lesions by CT, or hypoechoic or anechoic lesions by ultrasound in all but two cases in which hilar lesions resulted in biliary dilatation, both demonstrated by ultrasound.

Review of our primary cases indicated no association with cirrhosis or AIDS in contradistinction to the worldwide experience. There were no significant complications in the 15 patients in the study, and a definite diagnosis of lymphoma was made in all the cases with no need to proceed to surgical biopsy. We highly recommend image-guided core-needle biopsy of the liver as a reliable and useful tool for the diagnosis of hepatic lymphoma.