Randomized Controlled Trial of Aspiration Needle versus Automated Biopsy Device for Transjugular Liver Biopsy

doi:10.1016/S1051-0443(07)61479-1

Journal of Vascular and Interventional Radiology

Volume 12, Issue 5, May 2001, Pages 583-587

https://doi.org/10.1016/S1051-0443(07)61479-1 Get rights and content

PURPOSE

The efficacy and safety of transjugular liver biopsy used to obtain liver specimens in patients with coagulation disorders have been widely proven. However, histopathologic examination is not always possible because of fragmented samples provided by the aspiration technique. Recently, an automated device with a Tru-Cut–type needle was designed. In this randomized controlled trial, the use of this new device is compared with the traditional method in terms of efficacy and safety.

METHOD

Fifty-six patients were included in the study; 28 were randomized to undergo the aspiration technique and 28 were randomized to undergo the automated biopsy technique.

RESULTS

Correct positioning of the device was achieved in 93% of patients undergoing the aspiration technique and 96% of patients undergoing the automated biopsy technique (P = NS). Mean duration of the procedure and total number of passes were significantly higher in the aspiration needle group than in the automated device group (22.6 min ± 12.6 vs 15.5 min ± 9.4; P = .03, and 3.3 min ± 1.9 vs 1.5 min ± 0.63; P < .001, respectively). The number of portal tracts was significantly higher in the automated device group (4.7 ± 2.5 vs. 2.7 ± 3.4; P < .05). Adequate specimens for histopathologic evaluation were obtained in 26 patients in the automated device group and 24 patients in the aspiration needle group (92.8% vs 85.7%; P = NS), but a definite histopathologic diagnosis was more frequently obtained with the automated biopsy device (68% vs 43%; P = .05). No significant differences were observed in complication rates (7.14% vs. 10.7%; P = NS).

CONCLUSIONS

The automated biopsy device for transjugular liver biopsy is more effective than an aspiration needle in obtaining good samples for a definite histologic diagnosis.

Section snippets

Patients

Fifty-six consecutive patients who presented to our Hepatic Hemodynamics laboratory for transjugular liver biopsy between September 1996 and February 1998 were included in the study. All the patients gave their consent after being provided full information of the characteristics of the study. The study was approved by the Ethical Committee of our hospital and was conducted in accordance with principles of the Declaration of Helsinki.

Patients were randomly allocated to undergo transjugular liver

RESULTS

Samples for histopathologic examination were taken in 26 patients in the automated needle group and in 24 patients in the aspiration needle group. In one patient in the automated device group and in two patients in the aspiration group, correct position of the biopsy device into the hepatic vein could not be achieved. The specimens obtained were too small for histologic examination in two patients in the aspiration needle group and one patient in the automated needle group (Table 2).

The mean

DISCUSSION

Transjugular liver biopsy is an efficacious, safe, and widely accepted procedure to obtain liver tissue when the percutaneous approach is contraindicated (1, 2, 3, 4). This procedure allows the retrieval of an adequate liver sample in the majority of cases.

However, the major limitation of the classic aspiration technique is fragmentation of the sample, which precludes a definite diagnosis of the architecture of the liver in a high percentage of cases (2), particularly in patients with marked

References (12)

D Lebrec et al.
Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure
Gastroenterology
(1982)
AF Little et al.
Transjugular liver biopsy: a prospective study in 43 patients with the Quick-Core biopsy needle
J Vasc Interv Radiol
(1996)
F Piccinino et al.
Complications following percutaneous liver biopsy: a multicentre retrospective study on 68,276 biopsies
J Hepatol
(1986)
DB McGill et al.
A 21-year experience with major hemorrhage after percutaneous liver biopsy
Gastroenterology
(1990)
HJM Bull et al.
Experience with transjugular liver biopsy
Gut
(1983)
P Gamble et al.
Transjugular liver biopsy: a review of 461 biopsies
Radiology
(1985)

There are more references available in the full text version of this article.

Cited by (38)

Transjugular Liver Biopsy
2021, Techniques in Vascular and Interventional Radiology
Citation Excerpt :
Several studies have also shown high rates of adequate histologic samples are able to be obtained with TJLB, similar to those obtained by a percutaneous or even surgical route, despite the smaller gauge and fewer CPTs.20,39-41 It should be noted that these equivalent rates are with the core biopsy needles such as those found in the TJLB kit; aspiration utilizing a Colapinto needle has been found to have inferior adequacy.42,43 In conclusion, TJLB is an important alternative to percutaneous nonfocal liver tissue biopsies.
Transjugular liver biopsy (TJLB) was first performed in 1970 and has since become a standard procedure in interventional radiology practices. TJLB can be used when a percutaneous liver biopsy is contraindicated, such as patients with ascites, coagulopathy, congenital clotting disorders or for patients undergoing concurrent evaluation for portal hypertension. While TJLB specimens tend to be smaller with less complete portal triads numerous studies have shown the samples to be adequate for diagnosis and staging. This article will review what the interventional radiologist needs to know about TJLB including indications/work-up, technical details, tips and tricks, and complications.
Comparison of the diagnostic quality of aspiration and core-biopsy needles for transjugular liver biopsy
2020, Digestive and Liver Disease
Citation Excerpt :
Other studies report similar length and number of PT, but a higher percentage of incomplete PT. [11] In TJLB, studies reported longer [12–14] and less fragmented samples [13,14], together with more PT [15] as well as a higher possibility of adequate specimens using core-biopsy needles. [12,13] However, in our experience aspiration biopsy needles of larger diameter yield good results in some patients with chronic liver disease, usually in lower stages of fibrosis. [16]
Liver biopsy remains essential for the diagnostic work-up of patients with liver disease.
To evaluate aspiration vs. core-biopsy needles for transjugular liver biopsy (TJLB) in patients undergoing hepatic venous pressure gradient (HVPG) measurements.
84 patients undergoing TJLB between 06/2017 and 12/2018 were prospectively included. Liver biopsy specimens were systematically evaluated for quantitative and qualitative criteria such as number of portal tracts, sample length and fragmentation.
In direct comparison of paired TJLB specimens (n=35), core-biopsy samples were significantly longer (median 12 vs. 9mm, p=0.012), tended to contain more portal tracts (median 8 vs. 6, p=0.064) and were less fragmented (p<0.001), which resulted in better confidence for liver fibrosis assessment (p=0.035). However, a superior quality in terms of less fragmentation of core-biopsy specimens (p<0.05) was only confirmed in patients with HVPG ≥10mmHg or liver stiffness measurement >40kPa. In contrast, the aspiration needle provided significantly longer samples in patients with HVPG <10mmHg (median 21 vs. 12mm, p=0.007) or with liver stiffness measurement <20kPa (median 21 vs. 11mm, p=0.025).
In patients with HVPG ≥10mmHg, we recommend to performed TJLB using core-biopsy needles, while the aspiration needle provides high quality liver biopsy specimens in patients with HVPG <10mmHg.
Transvenous Pressure Measurements and Liver Biopsy
2020, Image-Guided Interventions: Expert Radiology Series, Third Edition
The portal pressure gradient is considered clinically significant when greater than 10 mmHg. Portal hypertension is classified as prehepatic, hepatic, or posthepatic, depending on the anatomical site of flow impedance. The hepatic venous pressure gradient (HVPG) is considered the gold standard for evaluating the portal pressure gradient in cirrhotic patients with hepatic portal hypertension. HVPG is the difference between wedged hepatic venous pressure and the free hepatic venous pressure. The HVPG correlates closely with stage and outcomes in cirrhosis and accurately predicts mortality. Liver biopsy plays a central role in the diagnosis and management of both diffuse and focal liver disease. In diffuse disease, histopathological assessment establishes etiology and, by determining stage and severity, aids prognostication and management decisions. When contraindications to percutaneous liver biopsy are present, transjugular liver biopsy (TJLB) can be performed. TJLB minimizes the risk of hemorrhage because the liver capsule is not punctured and theoretically any bleeding should return to the venous circulation. Regarding liver biopsy, utilization of a coaxial system has the advantage of allowing multiple samples to be taken from a single-entry point and facilitates subsequent plugged biopsy. Coaxial biopsy is considered the preferred technique by many operators.
Transjugular liver biopsy
2014, Clinics in Liver Disease
Transjugular liver biopsy: Indications, technique and results
2014, Diagnostic and Interventional Imaging
Citation Excerpt :
At present only the Quick-Core® Biopsy Needle has been studied by a large number of studies (Fig. 2) [21]. The other system (FlexCore® Biopsy Needle) has been the subject of only a few comparative studies, but the comparison was in favor of the FlexCore® system in terms of fragmentation and number of portal triads in the specimens [20,21]. The hepatic pressure gradient is obtained by measuring the wedge pressure and the free hepatic venous pressure [22].
Transjugular liver biopsy is a safe, effective and well-tolerated technique to obtain liver tissue specimens in patients with diffuse liver disease associated with severe coagulopathies or massive ascites. Transjugular liver biopsy is almost always feasible. The use of ultrasonographic guidance for percutaneous puncture of the right internal jugular vein is recommended to decrease the incidence of local cervical minor complications. Semiautomated biopsy devices are very effective in obtaining optimal tissue samples for a precise and definite histological diagnosis with a very low rate of complication. The relative limitations of transjugular liver biopsy are the cost, the radiation dose given to the patient, the increased procedure time by comparison with the more common percutaneous liver biopsy, and the need of a well-trained interventional radiologist.
Liber biopsy
2012, Medicine (Spain)
Aunque se han desarrollado medidas no invasivas de la fibrosis hepática, aún hay muchos contextos clínicos en los que la información derivada de la biopsia hepática es insustituible. El abordaje percutáneo es el más frecuente, aunque se puede recurrir ocasionalmente a otros abordajes como, por ejemplo, el acceso transvenoso o laparoscópico, dependiendo de los riesgos individuales del paciente y la experiencia local. Estos accesos alternativos se contemplan en situaciones clínicas en las que el riesgo de la biopsia hepática percutánea es alto, o si se precisa información adicional (por ejemplo, medida de gradiente de presión venosa hepática). Una técnica cuidadosa es esencial para obtener una muestra de calidad y para minimizar los riesgos inherentes del procedimiento.
Although novel non-invasive measurements of liver fibrosis have been developed, there are still many situations in clinical practice in which the information derived from liver biopsy is irreplaceable. The percutaneous approach is the most common, however other approaches may be used such as transvenous or laparoscopic, depending on the individual risks and local expertise. These alternative accesses are contemplated in clinical situations in which the risk of percutaneous biopsy is high or additional information is requested. (for example, portal pressure measurement). A careful technique is necessary in order to obtain a quality specimen and to minimize the risks inherent to the procedure.

View all citing articles on Scopus

View full text

Randomized Controlled Trial of Aspiration Needle versus Automated Biopsy Device for Transjugular Liver Biopsy

PURPOSE

METHOD

RESULTS

CONCLUSIONS

Section snippets

Patients

RESULTS

DISCUSSION

Gastroenterology

J Vasc Interv Radiol

J Hepatol

Gastroenterology

Experience with transjugular liver biopsy

Gut

Transjugular liver biopsy: a review of 461 biopsies

Radiology