Ultrasound-Guided Percutaneous Liver Biopsy

A Review on Obtaining Adequate Specimens

Journal article (2020)

Authors

Danny de Lange Student
J.J. van den Dobbelsteen Medical Instruments & Bio-Inspired Technology - Mechanical, Maritime and Materials Engineering
Adriaan Moelker Erasmus MC
N.J. van de Berg Erasmus MC, Medical Instruments & Bio-Inspired Technology - Mechanical, Maritime and Materials Engineering
Research Group
Medical Instruments & Bio-Inspired Technology (Mechanical, Maritime and Materials Engineering) (TU Delft)
Copyright: © 2020 Danny de Lange, J.J. van den Dobbelsteen, Adriaan Moelker, N.J. van de Berg
DOI
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https://doi.org/10.1115/1.4047543
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Published Date

2020

Language

English

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Faculty

Mechanical, Maritime and Materials Engineering

Department

Biomechanical Engineering

Research Group

Medical Instruments & Bio-Inspired Technology

Abstract

This literature review was conducted to evaluate liver biopsy adequacy, including total core length (TCL), number of portal tracts (PT), fragmentation, and complication rates, as a function of needle type and gauge. A systematic electronic search was performed in the Web of Science and Google Scholar databases, according to the PRISMA statement. Eligible data, describing in vivo percutaneous ultrasound-guided human liver biopsy quality outcomes, were compared to adequacy criteria of the American Association for the Study of Liver Diseases (AASLD, TCL ≥ 20 mm, PT ≥ 11). An adequate mean number of PTs was found in 83% of biopsy needles assessed between 2012 and 2019, compared to 0% between 1998 and 2004. For TCL, this was 44% and 33%, respectively. Increasing the needle diameter enhanced TCL (result in 50% of included studies) and PT count (100%), and reduced fragmentation rates (75%), whereas no effect on pain or complications was found (83%). In total, five needle types achieved adequate PT counts, using 16 G (3×), 17 G (1×), or 18 G (1×) needles. Adequacy was reached using either a core needle biopsy (CNB, 3×) approach with one pass, or a fine needle aspiration (FNA, 2×) approach with two passes. The recommendations for biopsy adequacy can be met using 16/17 G FNA or 16/18 G CNB needles. Currently, many publications still present substandard liver biopsy quality outcomes. Although minimizing biopsy invasiveness is desirable, a decreased diameter or number of passes is ill-judged when reliability of biopsy outcomes is at stake.