Liver biopsy in the diagnosis of hepatocellular carcinoma

Dysplastic nodules are the precursor lesions of hepatocellular carcinoma (HCC). Accurate diagnosis of dysplastic nodules and well-differentiated HCC is difficult with biopsy samples. Lesions often have regional variation of severity. Invasion of stroma, although a useful criterion of carcinoma, is seldom found on needle biopsies. Many criteria of neoplasia, such as widened plates and mitotic activity, are also found in reactive states. Thus, clinical history needs to be taken into consideration. No single criterion is sufficient for diagnosis of HCC. The best criteria for differentiation from dysplastic nodules on needle biopsies are (1) liver cell plates more than two cells in width or atypical plate structure, (2) high N/C ratio, and (3) nuclear atypia. The Laennec Classification of Hepatic Neoplasia may assist the standardization of these criteria.