Diagnosis of hepatic lesions: ultrasonically guided fine needle biopsy or laparoscopy?

We compared the results of ultrasonically guided fine needle aspiration biopsy and laparoscopy in 63 patients who underwent both procedures. In this series, fine needle biopsy showed a sensitivity of 75.6% with a 84.1% overall accuracy. Laparoscopy demonstrated a 74.3% sensitivity with an overall accuracy of 82.7%. The combination of both procedures achieved an overall accuracy of 98.4% with a sensitivity of 97.5%. In one case only (hepatic involvement by Hodgkin's lymphoma), both laparoscopy and ultrasonically guided fine needle biopsy failed to establish the diagnosis. In small and deeply located lesions, ultrasonography is the most useful guide for biopsy. Laparoscopy is irreplaceable in the diagnosis of cirrhosis and in hepatic biopsies requiring larger bore needles. With the increasing use of ultrasonically guided fine needle biopsy, laparoscopy finds new indications, particularly in the preoperative staging of small hepatocellular carcinoma.