Are you assuming that the hot spot in your RLQ on the OctreoScan is a primary carcinoid in the appendix, which is the origin of the small, presumably metastatic lesion, in the liver ? Very unlikely. More likely a carcinoid originates in the terminal ileum (which is so close to the appendix that the scan cannot differentiate between the two). Furthermore, appendiceal carcinoid only rarely spreads so far as the liver while carcinoids of the terminal ileum much more frequently do so. But if neither was seen as a mass on the CT scan or on colonoscopy or small intestine barium X-ray series (was this done?), they would be too small for, and it would be too dangerous, to do a needle biopsy. In short, needle biopsy of the liver is easier and safer.