Objective: To examine the diagnostic agreement of preoperative needle core biopsy (NCB) grading of hepatocellular carcinoma (HCC) compared with the final surgical pathologic tumor grade. Summary Background Data: Some centers have adopted protocols for selecting patients with HCC for transplantation based on tumor grade as determined by preoperative NCB. The validity of NCB to predict final tumor grade has not been previously assessed. Methods: A total of 211 patients who underwent hepatic resection, open radiofrequency, or transplantation for HCC between 1998 and 2004 were identified. Clinicopathologic, NCB, and surgical data were collected and analyzed using χ² and κ statistics. Results: A total of 120 (67.4%) of the 178 who underwent resection or transplantation had an NCB. On preoperative NCB, the majority of HCC cases were classified as well-differentiated (n = 35; 37.6%) or moderately differentiated (n = 44; 47.3%), while 14 (15.1%) cases were categorized as poorly differentiated. In contrast, when tumor grading was based on the final surgical specimen, there was a significantly higher proportion of HCC cases graded as poorly differentiated (well-differentiated, n = 34; 36.6%; moderately differentiated, n = 33; 35.5%; poorly differentiated, n = 26; 27.9%) (P < 0.05). The overall percent agreement of NCB and surgical pathology to determine tumor grade was poor (κ = 0.18, P < 0.0001). Whereas final pathologic tumor grade predicted the presence of microscopic vascular invasion (well, 15.7%; moderate; 31.9%, poor; 58.4%; P = 0.001), NCB grade did not (well, 23.7%; moderate, 28.0%; poor, 25.4%; P = 0.65). Conclusions: Selection of candidates for transplantation based on NCB tumor grade may be misleading, as NCB tumor grade often did not correlate with grade or presence of microscopic vascular invasion on final pathology. Clinicomorphologic criteria (tumor size, number) should remain the major determinants of eligibility for transplantation.

BACKGROUND.: To date, no consensus has been reached regarding which primary tumor subtypes are managed appropriately with hepatic metastectomy. Specifically, the role of hepatic resection for metastatic periampullary or pancreatic adenocarcinoma remains controversial.METHODS.: Between 1995 and 2005, 1563 patients underwent surgical resection for periampullary carcinoma (n = 608 patients) or pancreatic adenocarcinoma (head, n = 905 patients; tail, n = 50 patients). Data on demographics, operative details, primary tumor status, and—when indicated—extent of hepatic metastasis were collected.RESULTS.: Of the 1563 patients who underwent resection of periampullary or pancreatic adenocarcinoma, 22 patients (1.4%) underwent simultaneous hepatic resection for synchronous liver metastasis. The primary tumor site was ampullary (n = 1 patient ), duodenal (n = 2 patients), distal bile duct (n = 2 patients), or pancreas (head, n = 10 patients; tail, n = 7 patients). The majority of patients (86.4%) had a solitary hepatic metastasis, and the median size of the largest lesion was 0.6 cm. Hepatic metastectomy included wedge resection (n = 20 patients), segmentectomy (n = 1 patient), and hemihepatectomy (n = 1 patient). After matching patients on primary tumor histology and location, the median survival of patients who underwent hepatic resection of synchronous metastasis was 5.9 months compared with 5.6 months for patients who underwent palliative bypass alone (P = .46) and 14.2 months for patients with no metastatic disease who underwent primary tumor resection only (P < .001). Pancreatic (median, 5.9 months) versus nonpancreatic (median, 9.9 months) primary tumor histology was not associated with a difference in survival in patients who underwent resection of synchronous liver metastasis (P = .43).CONCLUSIONS.: Even in well selected patients with low‐volume metastatic liver disease, simultaneous resection of periampullary or pancreatic carcinoma with synchronous liver metastases did not result in long‐term survival in the overwhelming majority of patients. Cancer 2007. © 2007 American Cancer Society.

Colorectal cancer is the fourth most common type of cancer in the Western world and is the second leading cause of cancer-related deaths in the United States.¹ Approximately 35% to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease.² Surgical resection of colorectal liver metastases is associated with long-term survival rates of 35% to 58%.^3-9 Radiofrequency ablation (RFA) has been proposed as a means to increase the number of patients eligible for liver-directed therapy. In patients with extensive metastatic disease who would otherwise be ineligible for resection, ablative approaches are often used instead of or combined with hepatic resection.^3,10-12