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SIR 2026

Scientific Session

Interventional Oncology

Session: General IO 1

110 - Safety and Clinical Implications of Concurrent Biopsy of Neuroendocrine Liver Metastases at the Time of Liver-directed Therapy

Monday, April 13, 2026
3:09 PM - 3:18 PM ET
Purpose: Liver-directed therapy (LDT) utilizing embolization is commonly performed for treatment of neuroendocrine tumor liver metastases (NETLMs). Tumor grade informs treatment and may evolve over time, suggesting a role for serial biopsy. This study evaluates the safety of concurrent biopsy at the time of LDT and assesses whether such biopsy results altered patient management.

Materials and Methods: Patients with NETLMs were enrolled in an IRB-appproved prospective cohort study for genetic, proteomic and metabolic tumor characterisation at a single academic centre from 2016-2024. 18G core biopsies were obtained using coaxial technique at the time of LDT. Primary outcomes were adverse event (AE) rates per Society of Interventional Radiology guidelines, classified as major (additional intervention and/or hospitalization) or minor (no therapy/nominal therapy). Secondary outcomes included tumor grade change between biopsy samples and prior tissue samples and alterations in clinical management based on these results. Potential associations between clinical characteristics (biopsy location, number of cores and AEs were assessed by univariate analyses; p< 0.05 was significant.

Results: Eighty-seven biopsies performed in 77 patients were included in the primary analysis. Diagnostic yield was 92% (80/87). A mean of 8 core biopsies (SD 1.76) were taken from the same lesion per procedure. Median interval from baseline biopsy was 1.7 (IQR 0.7-3.6) years. Biopsy-related AEs occurred in 8% of cases (7/87); major in 2% (2/87) including: 1) an arterioportal/arteriobiliary fistula resulting in hemobilia and a main portal vein thrombosis (PVT), and 2) perihepatic bleeding requiring an additional embolization. Both patients fully recovered. Minor AEs included asymptomatic arterioportal (n=1) and arteriovenous (n=1) fistulas, subcapsular/perihepatic hematoma (n=2), and segmental PVT (n=1). No significant associations of AEs with clinical characteristics were found. Among 63 patients eligible for grade change analysis, 27 (43%) had a change in tumor grade: 8 (13%) decreased and 18 (30%) increased. Seven of 18 patients (39%) with increased grade consequently underwent changes in clinical management, indicating a number needed to treat of 9 for biopsy-related management change.

Conclusion: Concurrent biopsy of NETLMs at the time of LDT has an acceptable AE rate and yielded clinically actionable information regarding grade change in a substantial proportion of patients. These findings suggest concurrent biopsy at the time of LDT should be considered in those lacking recent tissue sampling.