We read with interest the recent work by Ho et al demonstrating mutational hyperactivation of mammalian target of rapamycin signalling in a subgroup of hepatocellular carcinoma (HCC).1 As Berasain and Lechel concluded that the prospect of a positive therapeutic response may outweigh the risk associated with the HCC biopsy procedure2 and histology is essential for confirming a diagnosis of intrahepatic cholangiocarcinoma (ICC),3 we revisited the performance of non-invasive HCC diagnosis as recommended by current guidelines (eg, American Association for the Study of Liver Diseases (AASLD)) in clinical practice.4 We retrospectively analysed all patients (n=182) in which a CT-guided liver biopsy was performed at a tertiary referral centre within a 9-year period due to the clinical differential diagnosis of HCC. After quality control, a total of 94 biopsies (figure 1A, see online supplementary table 1) could be evaluated. HCC development was associated with the presence of cirrhosis (n=51/65, p<0.001), which was also found in 27% (3/11) of ICC and 33% (1/3) of combined hepatocellular–cholangiocarcinoma (HCC–CC) patients. The number of false-positive non-invasive HCC diagnosis was higher in patients without cirrhosis (n=13/19; table …

中文翻译：

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重新审视肝细胞癌的无创诊断

我们饶有兴趣地阅读了 Ho 等人最近的工作，该研究证明了在肝细胞癌 (HCC) 亚组中哺乳动物雷帕霉素信号传导靶点的突变过度激活。 1 正如 Berasain 和 Lechel 得出的结论，积极治疗反应的前景可能会超过相关风险HCC 活检程序 2 和组织学对于确认肝内胆管癌 (ICC) 的诊断至关重要，3 我们根据当前指南（例如，美国肝病研究协会 (AASLD)）的建议重新审视了非侵入性 HCC 诊断的性能在临床实践中。4 我们回顾性分析了所有因 HCC 临床鉴别诊断而在 9 年内在三级转诊中心进行 CT 引导下肝活检的患者 (n=182)。经过质量控制，总共可以评估 94 次活检（图 1A，参见在线补充表 1）。HCC 的发展与肝硬化的存在相关（n=51/65，p<0.001），在 27% (3/11) 的 ICC 和 33% (1/3) 的肝细胞-胆管癌 (HCC) 中也发现了这种情况–CC) 患者。无肝硬化患者的假阳性非侵入性 HCC 诊断数较高（n=13/19；表 ...