Improving diagnostic accuracy in cirrhotic patients: a comprehensive multicenter analysis of contrast-enhanced ultrasound-guided biopsy in a large cohort of 2056 patients (original) (raw)

Abstract

Purpose

To investigate the factors influencing ultrasound-guided liver biopsy accuracy and develop a decision model for managing biopsy results.

Materials and methods

This prospective study enrolled 2056 adult patients with focal hepatic lesions from nine Chinese hospitals. Diagnostic accuracy was calculated, and variables were analyzed using multivariate logistic regression. A prediction model was constructed using chi-square automatic interaction detection.

Results

This study enrolled 2056 participants (1297 men, 759 women; mean age, 67.8 ± 10.8 years) with 2056 biopsied lesions (mean ± standard deviation: 4.0 ± 2.8 cm; range 0.7–17.7 cm), and 94.2% were accurately diagnosed. Two to three biopsy passes were significantly more accurate than one pass (95.1% vs. 87.3%, P < 0.001) and comparable to the accuracy of > 3 passes (95.1% vs. 93.2%, P = 0.408). Independent predictors of accurate diagnoses included absence of cirrhosis [2.428 (1.457–3.741), P < 0.001], CEUS guidance [1.899 (1.288–2.801), _P_ = 0.001], and number of biopsy passes > 1 [1.775 (1.103–2.855), P = 0.018]. The predictive decision tree model demonstrated that for cirrhotic patients who underwent CEUS-guided biopsy, the probability of an accurate diagnosis increased from 88.3% (when US-guided biopsy was used) to 93.3%. Conversely, in noncirrhotic patients undergoing US-guided biopsy, a diagnostic accuracy probability of 96.4% was observed. The overall prediction accuracy of the model was 94.4%.

Conclusion

CEUS-guided biopsy enhances diagnostic accuracy in cirrhotic patients, whereas US-guided biopsy is highly accurate in noncirrhotic patients. Two to three needle punctures are sufficient for 95% accuracy, with no additional improvement from more punctures.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Khalifa A, Rockey DC (2020) The utility of liver biopsy in 2020. Curr Opin Gastroenterol 36(3):184–191
    Article PubMed PubMed Central Google Scholar
  2. Jones RP (2024) Lesional liver biopsies: better treatments, better studies, better science. Br J Surg 111(5):znae063
    Article PubMed Google Scholar
  3. Ercan C, Renne SL, Di Tommaso L, Ng CKY, Piscuoglio S, Terracciano LM (2024) Hepatocellular carcinoma immune microenvironment analysis: a comprehensive assessment with computational and classical pathology. Clin Cancer Res 30(22):5105–5115
    Article CAS PubMed Google Scholar
  4. Brusset B, Jacquemin M, Teyssier Y et al (2024) Radiological diagnosis of hepatocellular carcinoma does not preclude biopsy before treatment. JHEP Rep Innov Hepatol 6(1):100957
    Article Google Scholar
  5. Xie DY, Zhu K, Ren ZG, Zhou J, Fan J, Gao Q (2023) A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. Hepatobil Surg Nutr 12(2):216–228
    Article Google Scholar
  6. Tian G, Kong D, Jiang T, Li L (2020) Complications after percutaneous ultrasound-guided liver biopsy: a systematic review and meta-analysis of a population of more than 12,000 patients from 51 cohort studies. J Ultrasound Med 39(7):1355–1365
    Article PubMed Google Scholar
  7. Varela-Ponte R, Martínez-Lago N, Vieito-Villar M, Martin C-V (2022) Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. Radiologia (Engl Ed) 64(6):497–505
    Article CAS PubMed Google Scholar
  8. Chang Y, Kim JI, Lee B et al (2020) Clinical application of ultrasonography-guided percutaneous liver biopsy and its safety over 18 years. Clin Mol Hepatol 26(3):318–327
    Article PubMed PubMed Central Google Scholar
  9. Alturkistani H, Alsergani AH, Alzeer M, Alturkistani A, Zaini R, Bauones S (2024) Ultrasound-guided percutaneous liver biopsy: a review of what operators need to know. Medicine 103(30):e38673
    Article PubMed PubMed Central Google Scholar
  10. Dietrich CF, Nolsøe CP, Barr RG et al (2020) Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 46(10):2579–2604
    Article PubMed Google Scholar
  11. Yoo J, Lee DH (2024) Usefulness of contrast-enhanced ultrasound-guided biopsy for suspected viable hepatocellular carcinoma after treatment: a single-arm prospective study. Ultrasonography (Seoul, Korea) 43(2):88–97
    PubMed Google Scholar
  12. Sparchez Z, Mocan T, Craciun R, Sparchez M, Nolsøe C (2022) Contrast enhancement for ultrasound-guided interventions: when to use it and what to expect? Ultrasonography (Seoul, Korea) 41(2):263–278
    PubMed Google Scholar
  13. He Y, Gong L, Wu J, Wen B, Kong W (2025) The value of contrast-enhanced ultrasound fusion imaging in percutaneous liver biopsy for liver lesions invisible on conventional B-mode ultrasound. Quant Imaging Med Surg 15(2):1528–1542
    Article PubMed PubMed Central Google Scholar
  14. Wu W, Jing X, Xue GQ et al (2022) A multicenter randomized controlled study of contrast-enhanced US versus US-guided Biopsy of focal liver lesions. Radiology 305(3):721–728
    Article PubMed Google Scholar
  15. Huang JX, Shi CG, Xu YF et al (2022) The benefit of contrast-enhanced ultrasound in biopsies for focal liver lesions: a retrospective study of 820 cases. Eur Radiol 32(10):6830–6839
    Article PubMed Google Scholar
  16. Yang L, Zhang T, Wang L, Du J, Zhang H, Yi W (2024) Contrast-enhanced ultrasound versus conventional ultrasound in guided liver puncture biopsy: a systematic review and meta-analysis. Med Ultrason 26(3):301–309
    Article PubMed Google Scholar
  17. Al Bulushi Y, Cruz-Romero C, Kavandi H, Brook A, Brook OR (2023) Predicting successful ultrasound-guided biopsy of liver lesions. Abdom Radiol (NY) 48(11):3498–3505
    Article PubMed Google Scholar
  18. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England: 1990). 45(2):228–247
    Article CAS Google Scholar
  19. Kudo M, Kawamura Y, Hasegawa K et al (2021) Management of hepatocellular carcinoma in Japan: JSH consensus statements and recommendations 2021 update. Liver cancer 10(3):181–223
    Article CAS PubMed PubMed Central Google Scholar
  20. Liao Z, Tang C, Luo R, Gu X, Zhou J, Gao J (2023) Current concepts of precancerous lesions of hepatocellular carcinoma: recent progress in diagnosis. Diagnostics (Basel, Switzerland). 13(7):1211
    CAS PubMed PubMed Central Google Scholar
  21. Takeda H, Takai A, Eso Y, Takahashi K, Marusawa H, Seno H (2022) Genetic landscape of multistep hepatocarcinogenesis. Cancers 14(3):568
    Article CAS PubMed PubMed Central Google Scholar
  22. Terzi E, Iavarone M, Pompili M et al (2018) Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. J Hepatol 68(3):485–492
    Article PubMed Google Scholar
  23. Geyer T, Clevert DA, Schwarz S et al (2020) Diagnostic value of CEUS prompting liver biopsy: histopathological correlation of hepatic lesions with ambiguous imaging characteristics. Diagnostics (Basel, Switzerland). 11(1):35
    PubMed PubMed Central Google Scholar
  24. Sparchez Z, Mocan T, Hagiu C et al (2019) Real-time contrast-enhanced-guided biopsy compared with conventional ultrasound-guided biopsy in the diagnosis of hepatic tumors on a background of advanced chronic liver disease: a prospective, randomized, clinical trial. Ultrasound Med Biol 45(11):2915–2924
    Article PubMed Google Scholar
  25. Neuberger J, Patel J, Caldwell H et al (2020) Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 69(8):1382–1403
    Article PubMed Google Scholar
  26. Appelbaum L, Kane RA, Kruskal JB, Romero J, Sosna J (2009) Focal hepatic lesions: US-guided biopsy–lessons from review of cytologic and pathologic examination results. Radiology 250(2):453–458
    Article PubMed Google Scholar
  27. Chi H, Hansen BE, Tang WY et al (2017) Multiple biopsy passes and the risk of complications of percutaneous liver biopsy. Eur J Gastroenterol Hepatol 29(1):36–41
    Article PubMed Google Scholar
  28. Jing H, Yi Z, He E et al (2021) Evaluation of risk factors for bleeding after ultrasound-guided liver biopsy. Int J Gen Med 14:5563–5571
    Article PubMed PubMed Central Google Scholar
  29. Curti M, Piacentino F, Fontana F et al (2022) EVAR follow-up with ultrasound superb microvascular imaging (SMI) compared to CEUS and CT angiography for detection of type II endoleak. Diagnostics (Basel, Switzerland). 12(2):526
    PubMed PubMed Central Google Scholar
  30. Bertelli E, Vizzi M, Lattavo L et al (2025) Microvascular imaging versus CEUS in the characterization of renal masses: preliminary experience in a tertiary care referral university hospital. Ultraschall Med. https://doi.org/10.1055/a-2532-6772 (Epub ahead of print)
    Article PubMed Google Scholar
  31. Kratzer W, Güthle M, Dobler F et al (2022) Comparison of superb microvascular imaging (SMI) quantified with ImageJ to quantified contrast-enhanced ultrasound (qCEUS) in liver metastases-a pilot study. Quant Imaging Med Surg 12(3):1762–1774
    Article PubMed PubMed Central Google Scholar

Download references

Funding

This research was supported by the Beijing Municipal Science & Technology Commission (grant no. Z151100004015186).

Author information

Author notes

  1. Binbin Jiang, Xiang Jing, Yuxiang Wang and Xiaolin Zhu have made equal contributions.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, 100142, China
    Binbin Jiang & Kun Yan
  2. Department of Ultrasonography, Tianjin Third Central Hospital, Tianjin, China
    Xiang Jing
  3. Department of Ultrasonography, Shanxi Provincial Cancer Hospital, Taiyuan, China
    Yuxiang Wang
  4. Department of Hepatobiliary Cancer, Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
    Xiaolin Zhu
  5. Department of Ultrasonography, Yantai Qishan Hospital, Yantai, China
    Jing Wang
  6. Department of Ultrasonography, Shijiazhuang Fifth Hospital, Shijiazhuang, China
    Ruiqing Du
  7. Department of Ultrasonography, Jining No. 1 People’s Hospital, Jining, China
    Bin Lv
  8. Department of Ultrasonography, Cangzhou Infectious Disease Hospital, Cangzhou, China
    Kefeng Wang
  9. Department of Ultrasonography, Shanxi Provincial People’s Hospital, Taiyuan, China
    Zhixiang Gao

Authors

  1. Binbin Jiang
  2. Xiang Jing
  3. Yuxiang Wang
  4. Xiaolin Zhu
  5. Jing Wang
  6. Ruiqing Du
  7. Bin Lv
  8. Kefeng Wang
  9. Zhixiang Gao
  10. Kun Yan

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Binbin Jiang, Xiang Jing, Yuxiang Wang, Xiaolin Zhu, Jing Wang, Ruiqing Du, Bin Lv, Kefeng Wang and Zhixiang Gao. The first draft of the manuscript was written by Binbin Jiang, Xiang Jing and Kun Yan. All the authors commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence toKun Yan.

Ethics declarations

Competing interests

The authors have no relevant financial or nonfinancial interests to disclose.

Ethics approval

This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the institutional ethics committees of all participating centers.

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Cite this article

Jiang, B., Jing, X., Wang, Y. et al. Improving diagnostic accuracy in cirrhotic patients: a comprehensive multicenter analysis of contrast-enhanced ultrasound-guided biopsy in a large cohort of 2056 patients.Radiol med 130, 1297–1306 (2025). https://doi.org/10.1007/s11547-025-02034-7

Download citation

Keywords