Comparative Diagnostic Sensitivity of Endoscopic Ultrasound‐guided Tissue Acquisition for Hepatocellular Carcinoma Versus Intrahepatic Cholangiocarcinoma

Abstract

ABSTRACT Background and Aims Accurate histological differentiation between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is essential for selecting appropriate treatment. Endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) is increasingly used for focal liver lesions; however, comparative data on its diagnostic sensitivity for HCC and ICC remain limited. This study compared the diagnostic sensitivity of EUS‐TA for these malignancies. Methods This single‐center retrospective study included patients who underwent EUS‐TA for focal liver lesions and were ultimately diagnosed with HCC or ICC between 2016 and 2024. Patients with extrahepatic cholangiocarcinoma were excluded. The primary outcome was overall diagnostic sensitivity. Secondary outcomes were cytological sensitivity and procedure‐related adverse events. Results Forty‐five patients were included (HCC, n = 18; ICC, n = 27). Median lesion size was 41 mm. Baseline characteristics were similar, except that fine‐needle biopsy needles were used less frequently in HCC than in ICC (16.6% vs. 48.1%, p = 0.032). Overall diagnostic sensitivity was high in both groups but lower in HCC than in ICC (83.3% [95% confidence interval {CI}, 58.6–96.4%] vs. 100% [95% CI, 87.2%–100%], p = 0.029). The difference was more pronounced for cytological sensitivity (22.2% [95% CI, 6.4%–47.6%] vs. 77.8% [95% CI, 57.7%–91.4%], p = 0.0007). No procedure‐related adverse events occurred. Conclusions EUS‐TA demonstrated high diagnostic sensitivity for both HCC and ICC without procedure‐related adverse events. However, diagnostic sensitivity, particularly cytological sensitivity, was lower in HCC, consistent with the known pathological characteristics of HCC and the established role of histological evaluation in its diagnosis. Trial Registration: N/A.