Christopher B Weldon1, Arin L Madenci2, Gregory M Tiao3, Stephen P Dunn4, Max R Langham5, Eugene D McGahren6, Sarangarajan Ranganathan7, Dolores H López-Terrada8, Milton J Finegold8, Marcio H Malogolowkin9, Jin Piao10, Li Huang11, Mark D Krailo10, Rebecka L Meyers12, Howard M Katzenstein13. 1. Departments of Surgery & Pediatric Oncology, Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA. Electronic address: Christopher.Weldon@childrens.harvard.edu. 2. Departments of Surgery & Pediatric Oncology, Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA. Electronic address: Arin.Madenci@childrens.harvard.edu. 3. Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 4. Department of Surgery, Nemours Children's Health System, Wilmington, DE. 5. Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. 6. Department of Pediatric Surgery, University of Virginia Health System, Charlottesville, VA. 7. Division of Pediatric Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. 8. Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. 9. Division of Hematology/Oncology, Department of Pediatrics, University of California Davis Comprehensive Cancer Center, Sacramento, CA. 10. Department of Preventive Medicine, University of Southern California, Los Angeles, CA; Children's Oncology Group, Monrovia, CA. 11. Children's Oncology Group, Monrovia, CA. 12. Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT. 13. Division of Hematology/Oncology, Department of Pediatrics, Nemours Children's Specialty Care/Wolfson Children's Hospital, Jacksonville, FL.
Abstract
BACKGROUND: The histopathological assessment of pediatric liver tumors at presentation is critical to establish a diagnosis, guide treatment, and collect appropriate research samples. The purpose of this study was to evaluate complications associated with different approaches to liver biopsy for newly diagnosed hepatoblastoma. METHODS: Children with hepatoblastoma were enrolled on Children's Oncology Group study AHEP0731 (September 2009-March 2012). This analysis evaluated the study cohort of initially unresectable patients who therefore underwent a biopsy procedure at diagnosis. The primary endpoint was clinically significant postbiopsy hemorrhage, defined as requiring red blood cell transfusion. RESULTS: We identified 121 children who underwent open (n = 76, 63%), laparoscopic (n = 17, 14%), or percutaneous (n = 28, 23%) liver biopsies. All biopsy procedures yielded adequate tissue for diagnosis. Postbiopsy hemorrhage requiring transfusion occurred after 26% (n = 31) of biopsies. Need for blood product transfusion most frequently occurred following open (n = 27/76, 36%) and laparoscopic (n = 4/17, 24%) biopsies, compared with percutaneous (n = 0/28, 0%) biopsies (p < 0.01). CONCLUSIONS: Pretreatment biopsy of pediatric liver tumors via a percutaneous approach yielded the lowest frequency of clinically significant hemorrhage requiring transfusion, without evidence of sacrificing diagnostic accuracy. LEVEL OF EVIDENCE: Level I.
BACKGROUND: The histopathological assessment of pediatric liver tumors at presentation is critical to establish a diagnosis, guide treatment, and collect appropriate research samples. The purpose of this study was to evaluate complications associated with different approaches to liver biopsy for newly diagnosed hepatoblastoma. METHODS:Children with hepatoblastoma were enrolled on Children's Oncology Group study AHEP0731 (September 2009-March 2012). This analysis evaluated the study cohort of initially unresectable patients who therefore underwent a biopsy procedure at diagnosis. The primary endpoint was clinically significant postbiopsy hemorrhage, defined as requiring red blood cell transfusion. RESULTS: We identified 121 children who underwent open (n = 76, 63%), laparoscopic (n = 17, 14%), or percutaneous (n = 28, 23%) liver biopsies. All biopsy procedures yielded adequate tissue for diagnosis. Postbiopsy hemorrhage requiring transfusion occurred after 26% (n = 31) of biopsies. Need for blood product transfusion most frequently occurred following open (n = 27/76, 36%) and laparoscopic (n = 4/17, 24%) biopsies, compared with percutaneous (n = 0/28, 0%) biopsies (p < 0.01). CONCLUSIONS: Pretreatment biopsy of pediatric liver tumors via a percutaneous approach yielded the lowest frequency of clinically significant hemorrhage requiring transfusion, without evidence of sacrificing diagnostic accuracy. LEVEL OF EVIDENCE: Level I.
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