To examine sonographic radiologic-pathologic correlation of primary and metastatic liver tumors. This may aid the interventional and diagnostic radiologist in procedural guidance and lesion characterization. Between 2010 and 2018, 913 ultrasound-guided biopsies of liver masses were performed at our institution. The echogenicity of a random sampling of 577 of these lesions (mean patient age, 61.5 years; 53% male) were reviewed from the procedural sonographic images of the biopsied lesions and correlated to the biopsy pathology diagnosis. Lesion echogenicity was characterized in reference to the hepatic background parenchyma as either hypoechoic, hyperechoic, or iso/hyperechoic with hypoechoic halo, or isoechoic. This was recorded from biopsy procedural dictation or jointly reviewed by a senior/junior radiology resident. Radiologic-pathologic correlation was confirmed with 2-year follow-up for benign results and repeat imaging/biopsy to amend false negative results. Upon final radiologic-pathologic correlation, 89% (510 of 572, reported in Table 1) were true positive for malignancy, 8% true negative (46) and 3% (16) false negative. Primary tumor class was associated with tumor echogenicity (Table 1). Melanoma, lymphoma and breast cancer were most associated with hypoechoic pattern and neuroendocrine tumors, gastrointestinal adenocarcinomas and hepatocellular carcinoma more associated with hyperechoic pattern (Table 1, P = 0.0002). Smaller lesion size was associated with hypoechoic compared to hyperechoic lesions (Table 1, P = 0.001). 69% of lesions less than 3 cm diameter (140/204) were hypoechoic compared to 50% if larger (162/322) (P <0.001). Histologic tumor differentiation was reported on a subset of cases with hypoechogenicity associated with tumor de-differentiation (P = 0.01) Tumor echogenicity immediately prior to biopsy was associated with the type of primary or metastatic hepatic tumor, tumor size and histologic differentiation. This small pilot study may guide the interventional radiologist in performing a biopsy and expected pathologic results.Table 1Malignant lesionsHypoechoic %(n)Hyperechoic %(n)Hypoechoic halo %(n)Isoechoic %(n)P valueN57% (302)29% (152)10% (50)4% (22)Tumor PrimaryMelanoma82% (31)5% (2)11% (3)4% (1).0002Lymphoma82% (18)9% (2)9% (2)0Breast77% (26)15% (5)6% (2)3% (1)Pancreatic adenocarcinoma70% (56)16% (13)6% (5)8% (6)cholangiocarcinoma66% (21)22% (7)6% (2)6% (2)Genitourinary59% (13)32% (7)5% (1)5% (1)Carcinoma of unknown primary55% (28)28% (14)12% (6)6% (3)Lung54% (14)31% (8)12% (3)4% (1)Hepatocellular carcinoma50% (38)40% (30)11% (8)0Other tumors50% (10)30% (6)12% (3)4% (1)Gastrointestinal carcinoma39% (31)44% (35)14% (11)3% (2)Neuroendocrine35% (16)50% (23)9% (4)7% (3)Biopsied lesion sizelesion size (cm)3.7, SD 2.14.5, SD 2.84.4, SD 1.94.7, SD 2.4.001Tumor histologic differentiationWell37% (18)51% (25)8% (4)4% (2).01Moderate52% (44)30% (25)14% (12)4% (3)Poorly63% (113)24% (44)8% (15)4% (8) Open table in a new tab