When an ultrasound or CT shows an occupying lesion in a patient, I would recommend doing a liver biopsy.
A liver biopsy is done by needle aspiration into the liver, removing tissue from the lesion. After the procedure of sectioning and staining, the tissue will be observed under a microscope to see if there are any cancer cells, this is called a histopathological examination. Under ultrasound or CT guidance the needle can be precisely inserted into the lesion, for an experienced doctor, the success rate can be up to 95%.
To carry out a biopsy, the skin needs to be punctured and tissue taken out, it looks pretty frightening and the mention of “biopsy” turns some patients pale. Even though there is an aesthesia administered for a biopsy procedure and there is no pain felt, people are still afraid. It seems fear of pain is instinctive for people and I'm no exception. If in 1998 a liver biopsy had been carried out upon discovery of my small lesion with a clear diagnosis; a timely early treatment would evidently be better than any later treatments.
The gold standard for cancer diagnosis is pathological examination. Neither the tumor marker test nor the latest imageological screening, including the PET-CT can be 100% correct. The pathological examination is the only authoritative “judge.” In my book ‘Nothing But The Truth’ there are three examples.
The first is a patient I met by chance in Jiangyin City of Jiangsu province who was receiving chemotherapy. He had a cough and chest pains for two months. A PET-CT scan he had in Shanghai discovered multiple lesions on his left lung which was considered to be late stage lung cancer. Perhaps we were destined for each other, he trusted me and immediately flew to Guangzhou. We did a lung biopsy for him and proved that he didn't have lung cancer but tuberculosis. Recently I called him,
he was so pleased that he repeatedly called me “benefactor.”
The second example is a former secretary of the Ministry of Transportation who was 76 years old, living in a “high-ranking” ward of a hospital in Beijing. He was diagnosed with lung cancer by both CT and PET-CT scan. As he was too old and feeble a doctor advised him to return home and “recuperate”. He was not willing to do this so he and his wife travelled thousands of miles taking a train for twenty-four hours to Guangzhou. We did a lung biopsy for him which concluded he had pneumonia.
The third example is an eighty-year-old man from Surabaya Indonesia, he had difficulty urinating so he went to Singapore to have physical examinations, and doctors there told him he had prostate cancer which was inoperable. He came to our hospital undergoing a prostate biopsy. The results showed he had benign prostatic hyperplasia which is entirely different to prostate cancer. The old gentleman was an entrepreneur, after going through this life and death experience he could see life clearly, he gave his enterprise to his son so he could travel around the world. Two years ago I went to Surabaya, the couple came to specially see me, we were all so deeply happy it was difficult to put into words.
The lesson is profound. There is a strict discipline in my hospital. Only when patients have a pathological report, no matter where the pathology was done, in another hospital or ours, can we undergo treatment. The biopsy is becoming progressively more important. Not only does it include microscope diagnosis but also immunohistochemistry and molecular genetic testing. This can determine the type of cancer and biological characteristics for guiding treatment, prognosis evaluation and even cancer prediction. Individualized treatments described below mainly rely on pathological and molecular pathological examinations.