Abstract No. 487 Expanding the diagnostic toolbox: introduction of core needle liver biopsies in Tanzania

Abstract

Hepatocellular carcinoma (HCC) is the fourth most common cancer in Africa and tends to present earlier with worse outcomes in Africa than in Europe and North America. Although risk factor management plays a key role in reducing the burden of HCC, early and accurate detection are equally as important. Additionally, for cultural reasons, patients wish to have pathologic confirmation of diagnosis even when there is no treatment available. In Tanzania, no core needle biopsies (CNBs) were routinely performed at the nation’s largest public hospital until the introduction of an interventional radiology (IR) service in 2018. All patients who underwent liver CNB by the IR service at Muhimbili National Hospital (MNH) from October 2018 to September 2020 were included in the study. All procedures were performed by Tanzanian IR trainees as primary operators. Patient and procedural data, including demographic information, complications, and pathology results were collected and analyzed. Data was stored in REDCap, a HIPAA-compliant data management platform. A total of 51 core needle biopsies of the liver were performed on 49 patients. While 22 were done under direct supervision by US visiting faculty (43.1%), 29 were done independently by Tanzanian IR fellows (56.9%). All 51 were technically successful. No minor complications occurred. One major complication (Society of Interventional Radiology Class C) occurred (patient developed abdominal pain and rigors 30 minutes post-procedure). Of the 38 samples returned, 37 were diagnostic (97.4%); 33 confirmed malignancy, the most common types of which were hepatocellular carcinoma (14/33, 42.4%) and metastatic disease (14/33, 42.4%). Previously at MNH, fine-needle aspiration was used to assess hepatic lesions. While cheaper, it is not as reliable as CNB, with a lower sensitivity, specificity, and diagnostic accuracy. The introduction of a superior method of diagnosing hepatic lesions has provided surgeons and oncologists with a tool for earlier diagnosis. Furthermore, with the introduction of new IR procedures like transarterial catheter embolization and radiofrequency ablation to the region, patients can expect better treatment and prolonged survival.