Even though biopsy is not necessary to confirm HCC when radiology images are clear, the recommendation is to obtain a biopsy when
1- Uncertain or atypical features on images
2- If patient can potentially recieve systemic therapy
The reality is, in the era of immunotherapy, biopsies can be informative of molecular and immune classes of HCC, oncogenic mutations associated with immune excluded phenotypes, and gene signatures predictive of response to immunotherapy, as well as for research and poblational studies.
THe overall sensitivity is 86–93% and depends on the size, location and histological differentiation of the tumour, as well as the pathologist´s expertise. In general lesions >2cm are usually easier diagnosed.
The international Consensus Group for Hepatocellular Neoplasia criteria applies: Stromal invasion, increased cell density, intratumoral portal tracts, unpaired arteries, pseudoglandular pattern, and diffuse fatty changes are typical findings.
Positive staining in two of four markers (glypican 3 [GPC3], glutamine synthetase, heat shock protein 70 [HSP70], and clathrin heavy chain) is highly specific for HCC. Extra K19 or CD34 staining can be considered to detect progenitor cell features.
