Introduction Liver biopsy is considered gold standard tool to investigate liver disease and provides valuable information which guides management1.Currently most liver biopsies in UK are performed under ultrasound guidance using size 18 guage needles but the adequacy of biopsy specimen varies and sometimes suboptimal. The British Royal College of Pathologists recommend a specimen size of at least 1 cm and a minimum of 6 portal tracts 2, whereas the AASLD guidelines recommend a biopsy length of 2 cm, a minimum of 11 portal tracts for histological diagnosis and using 16 guage needle.3
Methods Retrospective data from ultrasound guided liver biopsies performed in 2011 using 16 gauge co -axial biopsy needle was collected from radiology and pathology databases. Adequacy of biopsy specimen, diagnostic and complication rates were analysed and results compared to a similar group of patients in 18 gauge group at a tertiary centre in London.
Results 50 biopsies (n = 50)compared from both groups. Mean age 48 years (range 24–85).56% were females (n = 28).Indications were chronic hepatitis B (n = 20), chronic hepatitis C (n = 9), NASH (n = 5), focal liver lesions (n = 5), haemochromotosis (n = 2), PBC/AIH (n = 2) and others (n = 7).All biopsies were performed by radiology fellows or consultants.90%were non-targeted (n = 45) and majority were taken from the right lobe. The mean number of cores obtained in 16 gauge group were 2.08(range 1–5) as compared to 1.46 (range 1–4) in 18 gauge group. The mean length of specimen in the 16 gauge group was 14 mm and the mean (±SD) number of portal tracts per biopsy were 15 (±8.145) as compared to 7.5 (±4.47)in the 18G group (p < 0.001).The specimen was diagnostic in 96% in 16 gauge group as compared to 90% in 18 gauge group.5 patients had metastatic lesions and were excluded from analysis. There were no major complications in either groups and one patient in the 16 G group died due to underlying metastatic cancer within 30 days of biopsy.
Conclusion Liver biopsy performed using 16 gauge co-axial needle improves specimen quality and increases diagnosis rate significantly compared to 18 gauge needle. Despite being a larger bore needle, it is not associated with an increased rate of complications. We recommend using 16 gauge co-axial needles routinely for percutaneous liver biopsies.
Disclosure of Interest None Declared.
Guidelines on the use of Liver Biopsy in Clinical Practice: 2004. British Society Of Gastroenterology: (www.bsg.org.uk)
Tissue pathways for liver biopsies for the investigation of medical disease and for focal lesions: GO64, May 2008, The Royal College of Pathologists
Liver Biopsy :AASLD position statement : Don C. Rockey, Stephen H. Caldwell, Zachary D. Goodman, Rendon C. Nelson, Alastair D. Smith;HEPATOLOGY, Vol. 49, No. 3, 2009