Objective: Despite the prognostic significance of tumor grade and vascular invasion for patients with hepatocellular carcinoma (HCC), preoperative needle biopsy (PNB) is not routinely utilized for liver transplant (LT) recipient selection. We sought to evaluate diagnostic concordance of preoperative HCC grade to explant pathologic grade, correlation with explant vascular invasion, and assess whether incorporation of PNB to accepted transplant criteria improves candidate selection.

Methods: Clinicopathologic characteristics of HCC recipients with a pretransplant PNB from 1984-2014 were analyzed, and ability of PNB to improve prognostication of recurrence prediction models was assessed by multivariate competing-risk Cox regression analysis.

Results: Of 965 patients that underwent LT for HCC, 217 (23%) had a PNB. PNB tumor grade had poor concordance to final explant pathologic grade (κ = 0.25; p < 0.01), as well as low sensitivity (29%) and positive predictive value (40%) in identifying poorly differentiated tumors. Vascular invasion was predicted by explant pathologic grade (r_s = 0.25, p<0.01) but not PNB grade (r_s = 0.04, p=0.52; Figure 1). For predicting recurrence, addition of PNB did not improve prognostic performance of either the established radiologic Milan criteria (C statistic = 0.636 vs. 0.650, p = 0.86), or a model incorporating serum biomarkers (α-fetoprotein, neutrophil to lymphocyte ratio, and cholesterol) to the Milan criteria (C statistic = 0.696 vs. 0.701, p = 0.81).

Conclusions: Preoperative determination of HCC grade by PNB has low sensitivity and positive predictive value in identifying poorly differentiated tumors, with no correlation to explant vascular invasion or improvement of candidate selection. Incorporation of PNB to guide transplant candidate selection appears unjustified.

CITATION INFORMATION: Court C, Harlander-Locke M, Markovic D, Kaldas F, Zarrinpar A, Farmer D, Sho S, Tomlinson J, Hiatt J, Busuttil R, Agopian V, Lu D, Raman S. Is Pretransplant Determination of Hepatocellular Carcinoma Tumor Grade Using Needle Biopsy Reliable for Transplant Candidate Selection? Analysis of 217 Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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