ATU-5 Percutaneous liver biopsy to confirm advanced metastatic cancer: A step too far?

IntroductionLiver biopsy carries significant risks, including bleeding and death. It is routinely undertaken to confirm imaging evidence of hepatic metastases. However, establishing a cancer diagnosis beyond doubt is of limited benefit if a patient is not suitable for oncological therapy. We have therefore examined outcomes in patients undergoing liver biopsy for metastatic cancer.MethodsHospital Episode statistics were examined to identify patients undergoing percutaneous liver biopsy between 2010 and 2019 and diagnosed with metastatic cancer. Multivariable logistic regression examined risk factors for mortality at 14 and 30 days and receiving chemotherapy.Results30992 patients underwent liver biopsy for metastatic cancer (median age of 67 (IQR 59-74) years, 52% female). 28% underwent biopsy during an emergency inpatient stay and 9% died within 14 days and 27.6% within 30 days of their biopsy. In contrast, only 2.2% of patients having an outpatient biopsy died within 14 days and 8.6% within 30 days.Increased 30 day mortality was associated with: inpatient biopsy (odds ratio 3.37 (95%CI 3.15-3.61)) and increasing comorbidity (Charlson score 1-4: 1.21 (1.11-1.32)). Lower 30 day mortality was associated with all ages under 70 (for 18-29 yr olds: 0.35 (0.20-0.63)), a lymphoma diagnosis (0.69 (0.51-0.93)) and biopsy at a radiotherapy centre (0.89 (0.83-0.96)).14,244 (46%) patients received chemotherapy within 6 months of liver biopsy; 53% of those undergoing outpatient biopsy but only 33% of those biopsied as an inpatient. 18% of patients received only one dose of chemotherapy and 18% died within 14 days of chemotherapy. Receiving chemotherapy was negatively associated with biopsy as an inpatient (0.45 (0.42-0.47)) and increasing comorbidity (Charlson score 1-4 0.85 (0.80-0.91)). All ages under 70 (for 18-29 yr olds: 3.79 (2.67-5.39)) and female sex (1.06 (1.01-1.11)) were associated with receiving chemotherapy. Medium and high volume providers of biopsies were also associated with receiving chemotherapy compared to the lowest volume providers (1.13 (1.04-1.22) and 1.51 (1.39-1.64), respectively).ConclusionsMortality is high following liver biopsy to confirm metastatic cancer in patients admitted as an emergency. Only a third of such patients go on to receive chemotherapy. Clinicians should carefully consider the benefit of invasive diagnostics in those with metastatic cancer who are elderly, com-morbid or of poor performance status and multidisciplinary discu