Ultrasound-Guided Liver Biopsy in Real Life
Ultrasound-Guided Liver Biopsy in Real Life
Background and Aim: Currently, an increasing number of liver biopsies are performed by radiologists under real-time ultrasound control. A routine ultrasound assessment of a puncture site before performing percutaneous biopsy is reported to increase diagnostic yield and decrease complication rates. It is not clear if real-time ultrasound is superior to marking the puncture site before biopsy as regards reducing biopsy size and avoiding fragmentation and complications. The aim of this study was to compare ultrasound assessment of the puncture site before performing percutaneous liver biopsy with real-time ultrasound liver biopsy for suspected diffuse liver disease.
Methods: Consecutive percutaneous liver biopsies (n = 631) for diffuse liver disease were evaluated. Group A consisted of patients who had real-time guided-ultrasound biopsy performed by radiologists (241 patients; M/F, 35/106; median age 48 year [range, 17-76]; needle 18 G). Group B patients were assessed by radiologists using ultrasound of the puncture site on the same day that biopsies were performed by experienced gastroenterologists/hepatologists on the ward using the marked site (390 patients; M/F, 276/114; median age 43 year [range, 15-75]; needle 16 G).
Results: There were no differences in severity of liver disease, establishing a diagnosis (OR, 1.92 [95% CI, 0.84-4.34]; P = 0.12), length of liver biopsy specimens, number of fragments or complications. Two independent variables were significantly associated with a histological diagnosis: longer biopsy length (P < 0001) and fragment number of two or less (P < 0.001).
Conclusion: Real-time ultrasound did not improve diagnostic yield or result in fewer complications. Marking the puncture site seems adequate and has the practical advantage that it takes up less of the radiologists' time.
Traditionally, liver biopsy has been performed by hepatologists or gastroenterologists. Anatomical variation in livers may result in failure to obtain hepatic tissue at liver biopsy without imaging guidance using the so-called blind biopsy. In everyday clinical practice, an increasing number of liver biopsies are performed by radiologists under ultrasound control. Ultrasonography, as well as being a good screening test for liver disease, allows selection of the optimal puncture site before performing biopsy. The use of ultrasonography by marking the site for percutaneous biopsy has been reported to increase diagnostic yield and decrease complication rates.
It is not clear as to whether performing real-time ultrasound (i.e. at the time of liver biopsy) is any more effective than marking the puncture site shortly before biopsy , in terms of biopsy size, fragmentation and complications. Our aim was to assess these factors in a retrospective review of consecutive patients undergoing liver biopsies for suspected liver parenchymal disease.
Abstract and Introduction
Abstract
Background and Aim: Currently, an increasing number of liver biopsies are performed by radiologists under real-time ultrasound control. A routine ultrasound assessment of a puncture site before performing percutaneous biopsy is reported to increase diagnostic yield and decrease complication rates. It is not clear if real-time ultrasound is superior to marking the puncture site before biopsy as regards reducing biopsy size and avoiding fragmentation and complications. The aim of this study was to compare ultrasound assessment of the puncture site before performing percutaneous liver biopsy with real-time ultrasound liver biopsy for suspected diffuse liver disease.
Methods: Consecutive percutaneous liver biopsies (n = 631) for diffuse liver disease were evaluated. Group A consisted of patients who had real-time guided-ultrasound biopsy performed by radiologists (241 patients; M/F, 35/106; median age 48 year [range, 17-76]; needle 18 G). Group B patients were assessed by radiologists using ultrasound of the puncture site on the same day that biopsies were performed by experienced gastroenterologists/hepatologists on the ward using the marked site (390 patients; M/F, 276/114; median age 43 year [range, 15-75]; needle 16 G).
Results: There were no differences in severity of liver disease, establishing a diagnosis (OR, 1.92 [95% CI, 0.84-4.34]; P = 0.12), length of liver biopsy specimens, number of fragments or complications. Two independent variables were significantly associated with a histological diagnosis: longer biopsy length (P < 0001) and fragment number of two or less (P < 0.001).
Conclusion: Real-time ultrasound did not improve diagnostic yield or result in fewer complications. Marking the puncture site seems adequate and has the practical advantage that it takes up less of the radiologists' time.
Introduction
Traditionally, liver biopsy has been performed by hepatologists or gastroenterologists. Anatomical variation in livers may result in failure to obtain hepatic tissue at liver biopsy without imaging guidance using the so-called blind biopsy. In everyday clinical practice, an increasing number of liver biopsies are performed by radiologists under ultrasound control. Ultrasonography, as well as being a good screening test for liver disease, allows selection of the optimal puncture site before performing biopsy. The use of ultrasonography by marking the site for percutaneous biopsy has been reported to increase diagnostic yield and decrease complication rates.
It is not clear as to whether performing real-time ultrasound (i.e. at the time of liver biopsy) is any more effective than marking the puncture site shortly before biopsy , in terms of biopsy size, fragmentation and complications. Our aim was to assess these factors in a retrospective review of consecutive patients undergoing liver biopsies for suspected liver parenchymal disease.