Journal of Liver Cancer

Review Articles

Toward a future role for liver biopsy in HCC: literature evidence and survey-based perspectives from Korean experts: Hae Lim Lee, Su Jong Yu, Sung Hak Lee, Min Woo Lee, Han Ah Lee, Yuri Cho, Jeong-Ju Yoo, Ha Il Kim, Jae Geun Lee, Hye Won Lee, Jihyun An, Sun Young Yim, Pil Soo Sung, Jonggi Choi, Jae Hyun Yoon, Eun Ju Cho, Jinhong Jung, Dongho Hyun, Ijin Joo, Yu Rim Lee, YoungRok Choi, Bo Hyun Kim, Sung Hyun Kim, Soon Sun Kim, Jeong-Han Kim, Haeryoung Kim, Pyoung-Jae Park, Hyun Phil Shin, Ki Tae Yoon, Sang Min Yoon, Minjong Lee, Jai Young Cho, Jin-Young Choi, Do Young Kim, June Sung Lee, Mi-Sook Kim, Kyung Sik Kim; J Liver Cancer. 2026;26(2):205-219. Published online September 3, 2026; DOI: https://doi.org/10.17998/jlc.2026.08.27

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Abstract PDF: The role of liver biopsy in hepatocellular carcinoma (HCC) is being re-evaluated in the era of precision oncology and biomarker-driven systemic therapy. Although histopathological examination remains the diagnostic gold standard, HCC is unique among solid tumors in that accurate non-invasive imaging criteria allow diagnosis without routine biopsy in selected clinical settings. However, increasing biological heterogeneity, expanding therapeutic options, and the growing need for molecular stratification have renewed interest in tissue-based evaluation. Recent international guidelines have gradually broadened the indications for liver biopsy, particularly in selected diagnostic scenarios, prior to systemic therapy, and for molecular profiling. Beyond diagnostic confirmation, liver biopsy provides important information for histological subtyping, prognostic stratification, and biomarker discovery. Advances in immunohistochemistry, next-generation sequencing, and artificial intelligence-assisted pathology have further enhanced the clinical value of tumor tissue. In parallel, contemporary cohort studies indicate that liver biopsy is associated with low complication rates when modern techniques and standardized peri-procedural management are applied. Despite these advances, the integration of liver biopsy into routine clinical practice remains limited. To contextualize this gap, the Korean Liver Cancer Association conducted a nationwide survey of HCC specialists. The survey showed that liver biopsy is infrequently performed in current practice due to perceived procedural risks and limited immediate impact on therapeutic decision-making. Taken together, accumulating evidence supports a reappraisal of the clinical role of liver biopsy in HCC. Optimizing procedural safety, standardizing indications, and integrating tissue-based molecular insights into therapeutic decision-making may help bridge the gap between emerging evidence and real-world practice.

The Genomic Landscape and Its Clinical Implications in Hepatocellular Carcinoma: Sun Young Yim, Ju-Seog Lee; J Liver Cancer. 2019;19(2):97-107. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.97

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The pathogenesis of hepatocellular carcinoma (HCC) is a complex process. During the last decade, advances in genomic technologies enabled delineation of the genomic landscape of HCC, resulting in the identification of the common underlying molecular alterations. The tumor microenvironment, regulated by inflammatory cells, including cancer cells, stromal tissues, and the surrounding extracellular matrix, has been extensively studied using molecular data. The integration of molecular, immunological, histopathological, and clinical findings has provided clues to uncover predictive biomarkers to enhance responses to novel therapies. Herein, we provide an overview of the current HCC genomic landscape, previously identified gene signatures that are used routinely to predict prognosis, and an immune-specific class of HCC. Since biomarker-driven treatment is still an unmet need in HCC management, translation of these discoveries into clinical practice will lead to personalized therapies and improve patient care, especially in the era of targeted and immunotherapies.

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Case Reports

Clinical Outcome of Completely Ablated Hepatocellular Carcinoma in Single Session in Patients with Decompensated Liver Cirrhosis: Min Seon Park, Soon Ho Um, Ho Sang Ryu, Yeon Seok Seo, Sun Young Yim, Chang Ho Jung, Tae Hyung Kim, Dae Hoe Gu; J Liver Cancer. 2014;14(2):139-142. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.139

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Abstract PDF: Most cases of hepatocellular carcinoma (HCC) occur in the Asia-Pacific region and in patients with underlying hepatitis B and C viral infection. Although surgical resection is the gold standard for treatment of HCC, only a few patients are surgical candidates because of their lack of hepatic reserve. Liver transplantation, which eradicates HCC and replaces damaged noncancerous hepatic parenchyma, is regarded as the best treatment for HCC in patients with decompensated liver cirrhosis. However, the shortage of donors limit its widespread use. Furthermore, the long waiting time for liver transplantation allow for tumor progression and reduce patient survival. Given this long wait, there is a reasonable clinical need in the meantime for minimally invasive methods to avoid progression of HCC in patients with decompensated liver cirrhosis. We herein offer our experiences of therapeutic efficacy and complications of the procedure and the changes in liver function before and after TACE and radiofrequency ablation in patients with HCC and decompensated liver cirrhosis, defined as a Child-Pugh-Turcotte score above 7. (J Liver Cancer 2014;14:139-142)

Two Cases of Small (< 1 cm) Hepatocellular Carcinoma: Jin Yong Jung, Sun Young Yim, Chang Ha Kim, Jin Dong Kim, Yeon Seok Seo, Hyung Joon Yim, Ho Sang Ryu, Min Ju Kim, Beom Jin Park, Soon Ho Um; Journal of the Korean Liver Cancer Study Group. 2012;12(1):37-41. Published online February 28, 2012

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Abstract PDF: Tumor size is one of the most important factors for decision of therapeutic plan and prognosis of hepatocellular carcinoma (HCC). If the diagnosis of HCC is made earlier in its small size, the prognosis is better. However the diagnosis of small HCC is not easy because small HCC lacks the typical clinical and radiologic feature. We experienced two cases of small HCC less than 1 cm that was confirmed after first treatment.

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