Aim: Once a diagnosis of HCC is made on Magnetic Resonance Imaging (MRI), a liver biopsy is often undertaken for tissue diagnosis. We examined whether biopsy in such cases is really necessary. Methods & Results: Of all 998 liver biopsies performed in our University Hospital between January 2007 and January 2013, 26 had a histological diagnosis of HCC. 8 of these had prior liver MRI, of which 4 were reported as HCC. In all 4 cases, the alpha fetoprotein (AFP) was raised. On the other hand, 25 of the 26 patients had prior Computer-assisted Tomography (CT), with only 5 reported as HCC. Moreover, of all 95 urgent or scheduled MRI Liver scans performed in our hospital between Jan 2011 and Dec 2012, 2 were reported as HCC, and both were confirmed on biopsy. Discussion: Whilst our study, to date, has limited power, we advocate MRI as a first line investigation for suspected HCC. Moreover, in cases where the MRI shows a diagnosis of HCC and the AFP is raised, we argue that a liver biopsy, which itself carries risks, may not be necessary. However, in cases where the AFP is raised, and the MRI is suspicious for HCC, but cannot exclude metastasis, we would advocate a liver biopsy. This is because there are reported cases in the literature of AFP-producing gastric cancers with liver metastases.

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