https://www.ncbi.nlm.nih.gov/pubmed/31126688 Hepatoblastoma
J Pediatr Surg. 2019 May 11. pii: S0022-3468(19)30347-1. doi: 10.1016/j.jpedsurg.2019.05.004. [Epub ahead of print]

Evaluation of the diagnostic biopsy approach for children with hepatoblastoma: A report from the Children's Oncology Group AHEP 0731 Liver Tumor Committee.

Weldon CB1, Madenci AL2, Tiao GM3, Dunn SP4, Langham MR5, McGahren ED6, Ranganathan S7, López-Terrada DH8, Finegold MJ8, Malogolowkin MH9, Piao J10, Huang L11, Krailo MD10, Meyers RL12, Katzenstein HM13.

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%) liverbiopsies. 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.