Role of imaging-guided biopsy for hepatocellular carcinoma

Percutaneous imaging-guided biopsy of hepatocellular carcinoma (HCC) is a relatively safe procedure with an established diagnostic role, and a growing value in providing prognostic and treatment information for patient's management. Because of the high specificity and positive predictive value of tumoral features on cross-sectional imaging studies, the number of biopsies performed for HCC is limited to certain specific clinical scenarios. However, routine imaging fails to fully capture the tumor's molecular heterogeneity, and as research unravels the potential of tumoral histopathological and molecular stratification, biopsy is poised to transition from a diagnostic tool to a powerful prognostication instrument, contributing to guiding personalized treatment management for patients with HCC. In this review paper, we explore the role of percutaneous, imaging-guided biopsy in the diagnosis, prognosis, and treatment of HCC.