The Importance of Experience in Percutaneous Liver Biopsies Guided with Ultrasonography (original) (raw)

Percutaneous liver biopsies guided with ultrasonography: a case series

Iranian journal of radiology : a quarterly journal published by the Iranian Radiological Society, 2013

Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur. To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease. In our retrospective study, we evaluated ultrasound-assisted needle biopsies that were performed in outpatients from October 2006 to July 2010. The liver biopsies were performed following one-night fasting using the tru-cut biopsy gun (18-20 gauge) after marking the best seen and hypovascular part of the liver, distant enough from the adjacent organs. A total of 1018 patients were referred to our radiology department. Most of the patients had hepatitis B (60.6%). The biopsy specimens were recorded and sent to our pathology department for histopathological examination. According to the results of our series, percutaneous liver biopsy using the tru-cut biopsy gun guided by ultrasonography can be performed safely....

The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy

Hepatology, 1996

Percutaneous liver biopsies are frequently performed opsy is low, but discomfort is common and complications to establish the diagnosis, assess prognosis, and monirequire hospitalization in approximately 4% of patients. tor therapy for various liver diseases. Although the rate The optimal method of performing these biopsies is unof serious complications is õ1%, the rate of complicaknown. The goal of our study was to determine whether tions requiring hospitalization is around 4% and failure the use of ultrasonography in the biopsy room immedito obtain liver tissue occurs in approximately 2% of ately prior to or during the procedure would lessen the patients. 1-4 It has been assumed by many that ultrarisk of complications and to compare the safety and effisound enhances the safety of liver biopsy, but few concacy in obtaining tissue by use of a Trucut needle versus trolled trials of ultrasound versus blinded biopsies in an automatic biopsy needle. Between 1992 and 1994, 836 the absence of suspected masses have been published. 5 patients were entered into a randomized study (489 in Rochester, MN; 347 in Barcelona, Spain). Patients were If ultrasound prevented complications of liver biopsy randomized immediately prior to liver biopsy into four while at the same time increasing the yield of diagnosgroups: Trucut needle, or automatic biopsy needle, and tic liver tissue, the additional expense might be justiwith or without ultrasonography. Fisher's Exact Test fied. and a logistic regression model were also used to assess The complication rates with a cutting-type needle the effect of needle and ultrasonography on the odds for (Trucut or Silverman) and an aspiration-type needle complications. The four biopsy groups were well-(Jamshidi or Menghini) still are debated, 1,3,6 but probamatched at entry with respect to age, sex, underlying bly are about the same. However, the yield of liver liver disease, hemoglobin, prothrombin time, and platetissue from fibrotic livers is thought to be higher with let count. The use of ultrasound was associated with a the cutting-type needle. 7 An automatic biopsy needle decreased rate of hospitalization for pain, hypotension, or bleeding (2 vs. 9, P õ .05). No difference in safety was (Microvasive, Boston, MA) has been developed that thefound between the two types of needles. The number of oretically possesses the advantages of a cutting-type passes needed to obtain specimens was similar for all needle without the need for manual manipulation. 8 four groups. The average length of the specimen was Formal studies regarding the adequacy of the tissue slightly greater with ultrasonographic-guided biopsies obtained with this automatic biopsy needle have not (1.7 mm vs. 1.6 mm, P õ .05) and with biopsies obtained been performed. using the automatic biopsy needle when compared with Late complications occurring days to weeks after the Trucut needle (1.7 mm vs. 1.5 mm, P õ .05), but this liver biopsy have not been prospectively evaluated. Perdid not seem to be clinically important. The addition of sonal experience as well as reports from the literature ultrasonography reduces complications in patients unindicate that this may be a problem that has not been dergoing percutaneous liver biopsy. The type of needle appears to offer little difference in safety or yield of diag-adequately addressed. 9,10 In this study, we sought to nostic tissue. The use of ultrasonography for guidance determine whether the use of ultrasonography at the of percutaneous liver biopsy will lead to a lower rate of time of biopsy would improve the safety or diagnostic complications. The value of this benefit must be weighed yield, whether an automatic biopsy needle held any against the added cost of ultrasonographic guidance. advantage over the traditional Trucut needle, and

Percutaneous liver biopsy using an ultrasound-guided subcostal route

Digestive diseases and sciences, 2001

Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic ...

Liver biopsy: Analysis of results of two specialist teams

World journal of gastrointestinal pathophysiology, 2014

To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams. Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy wa...

Percutaneous Liver Biopsies: Safety and Efficacy

Türkiye klinikleri tıp bilimleri dergisi, 2010

The aim of this study was to evaluate effecacy and safety of percutaneous liver biopsy performed under the assistance of ultrasonography in diffuse liver disease. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This was a retrospective study. We evaluated the ultrasound-assisted liver biopsy procedures of 784 patients which were performed in an outpatient setting between October 2001 and July 2008. The liver biopsies were performed following one-night fasting using disposable Menghinitype suction needles (16 gauge) after marking the best seen part of the best-thickest liver part distant from the adjacent organs. Liver portion suitable for biopsy was marked in the intercostal area by the use of ultrasonography and performed by an experienced gastroenterologist. After the biopsies, the vital signs of all patients were monitored for 6-8 hours. The patients without any problems were discharged on the same day. The shapes, sizes and number of the biopsy specimens were recorded, and then they were sent to the pathology department for histolopathological examination. The next day, control ultrasounds of all patients were performed. R Re es su ul lt ts s: : Macroscopically adequate tissue was obtained in 780 cases (99.5%) with a mean tissue length of 15.5 mm. In 755 patients (96.4%), adequate tissue sample was obtained after one pass. After the procedure, severe pain requiring analgesia was seen in 13 patients (1.6%). There was no complication requiring hospitalisation. Major complication requiring intervention occurred in only one patient with chronic renal failure undergoing hemodialysis (0.12%). There were no deaths resulting from liver biopsies. C Co on n-c cl lu us si io on n: : According to the results of our series, we conclude that routine ultrasound of the puncture site is a quick, effective and, safe procedure. The complication rate is very low. The ultrasound assisted percutaneous liver biopsy modality should be used to all cases. K Ke ey y W Wo or rd ds s: : Liver; biopsy, needle; ultrasonography; complications Ö ÖZ ZE ET T A Am ma aç ç: : Diffüz karaciğer hastalıklarında perkütan karaciğer biyopsilerinin ultrasonografi kılavuzluğunda yapılması durumunda, etkinliğinin ve güvenilirliğinin değerlendirilmesidir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu geriye dönük çalışmada 2001 Ekim ile 2008 Temmuz ayları arasında, ayakta takip edilen 784 hastanın ultrasonografi kılavuzluğunda yaptığımız karaciğer biyopsisi işlemini değerlendirdik. Biyopsiler, bir gecelik açlığı takiben, ultrasonografi deneyimi olan gastroenterologlar tarafından karaciğerin en iyi-kalın ve komşu organlardan uzak kısmının en iyi görüldüğü yerin interkostal alanda işaretlenmesinden sonra, tek kullanımlık Menghini tipi biyopsi iğneleri (16 gauge) kullanılarak yapıldı. Biyopsilerden sonra, 6-8 saat boyunca, tüm hastaların yaşamsal bulguları takip edildi. Herhangi bir sorun gelişmeyen hastalar aynı gün taburcu edildi. Biyopsi örneklerinin şekilleri, büyüklükleri ve parçaların sayıları kaydedilerek histopatolojik inceleme için patoloji bölümüne gönderildi. Bir sonraki gün tüm hastaların kontrol ultrasonografileri yapıldı. B Bu ul lg gu ul la ar r: : Yedi yüz seksen hastada (%99.5), ortalama 15.5 mm uzunluğunda yeterli doku elde edildi. Yediyüzellibeş hastada (%96.4) yeterli doku örneği, ilk girişte elde edildi. İşlemden sonra, karaciğer biyopsisi yapılan 13 hastada (%1.6) analjezi gerektiren ciddi ağrı oldu. Hastaneye yatış gerektiren komplikasyon olmadı. Müdahale gerektiren ciddi komplikasyon, hemodiyalize giren kronik böbrek yetmezliği olan bir hastada gelişti (%0.12). Biyopsilerden kaynaklanan ölüm olmadı. S So on nu uç ç: : Çalışmamızın sonuçlarına göre, biyopsi giriş yerinin rutin ultrasonu ardından yapılan perkütan karaciğer biyopsisinin, hızlı, etkili ve güvenilir bir işlem olduğunu söyleyebiliriz. Komplikasyon oranı çok düşüktür. Tüm olgularda karaciğer biyopsisinin ultrasonografi kılavuzluğunda yapılması gerektiğini düşünüyoruz.

Percutaneous biopsy of the liver

Cardiovascular and Interventional Radiology, 1991

Retrospective evaluation of 510 percutaneous CT-guided biopsies of the liver mainly fineneedle aspiration biopsies for cytology (89% of cases), yielded an overall accuracy rate of 92% and a sensitivity of 94%. The relatively high percentage of false-positive diagnoses (7% of all benign tumors) may be reduced by more consistent consideration of possible errors in cytology and a more consistent use of large bore biopsies.

Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant

The American journal of gastroenterology, 2002

Percutaneous liver biopsy is an essential diagnostic tool utilized in the management of patients with liver disease. This procedure is generally performed by a physician and has a small but well-defined complication rate. We report on the complication rate and efficiency of ultrasound-assisted percutaneous liver biopsy performed by an experienced physician assistant. One thousand eighty-six consecutive outpatient liver biopsies (847 hepatic allografts and 239 native livers) were performed at a single center by a physician assistant between June, 1996 and June, 2000. Patients with hepatic mass lesions, unusual hepatic anatomy, and uncorrectable coagulopathy (international normalized ratio > 1.7, platelet count < 50 x 10(9)/L) were excluded. Bedside ultrasonography was used to determine the optimal site for the liver biopsy. Liver biopsies were performed with a 15-gauge Jamshidi aspiration biopsy needle. Patients were observed for 3 h after biopsy, followed by dismissal with sub...

Practice and complications of liver biopsy

Digestive Diseases and Sciences, 1993

Studies on the complication rate of liver biopsy have hitherto been conducted in referral hospital centers. They are therefore not representative for general practice where liver biopsy is performed by specialists and nonspecialists. In a postal nationwide survey, we approached all gastroenterologists and hospital internists to assess the complication rate and practice (setting, needle type, use of ultrasonography) of percutaneous liver biopsy performed in 1989 in Switzerland for diffuse liver disease. Two hundred eighty questionnaires were mailed and 252 were returned (response rate 90. 0%) 165 respondents (65.5%) performed 3501 biopsies while 87 respondents (34. 5%) did not practice liver biopsy; 67. 7% of biopsies were executed blindly and 32.3% were guided. Eight nonfatal and three fatal complications occurred. Hemorrhage was the most frequent complication (five cases) and was responsible for all three fatal outcomes. The overall complication rate was 0.31%, being distinctly lower in the group of gastroenterologists (0.11%) as compared to the group of internists (0. 55%; P = O. 031). The complication rate was 1.68% in the group of internists performing fewer than 12 biopsies pc:'year, while there was no complication in the group of internists performing more than 50 biopsies per year (P = O. 036). Complications were not related to the needle diameter or to the absence of ultrasonography before biopsy. In conclusion, this representative survey in Switzerland shows that the complication rate of liver biopsy is mainly related to the experience and training of the operator.