The Importance of Experience in Percutaneous Liver Biopsies Guided with Ultrasonography

Rationale and Objectives

The goal of this study is to emphasize the value of lesion-focused approach in ultrasonography (US)-guided solid liver lesion biopsies performed under our guidance.

Materials and Methods

In our retrospective study, after the standard preparation for US-guidance solid liver lesion biopsy was accomplished, we performed standard intercostal approach and the biopsy procedure though one of our patients experienced a major complication (pneumothorax). After this undesirable case, we reviewed our biopsy procedure and performed a lesion-focused approach technique as described in this article. A Tru-cut biopsy gun (18 gauge) was used in this trial. The liver biopsies were divided into two groups according to the biopsy technique and all results were compared with each other.

Results

A total of 202 solid liver lesion biopsies were was performed under the guidance of US between October 2007 and July 2010. One major complication occurred in first group. All of the minor complications occurred in the first group. In group 2, there were no complications. For this reason, all patients in group 2 were discharged home after a few hours. Patients with minor complications in the first group were observed an average of 6 hours. Adequate tissue for pathological diagnosis was similar in both groups.

Conclusion

The lesion-focused approach technique has the potential to reduce both complication rates and patient incompliance. Percutaneous liver biopsies performed with this technique using real-time US guidance are convincing and clinically beneficial.

Percutaneous liver biopsy (PLB) is considered one of the most important diagnostic tools when diagnosing and managing patients with liver disease. PLB is a well-established, widely, and routinely used procedure with low morbidity. However, it is invasive and carries small risks for serious complications .

Although blind percutaneous needle biopsy is the traditional technique, the use of ultrasound (US) guidance has increased considerably. The existing clinical practice of PLB considerably varies with an emphasis on the technique, the operator, types of biopsy needles, quality of biopsy specimens and the risk of complications . Because of these significant alterations in the practice, complication rates and biopsy material adequacy may show a discrepancy among practitioners.

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Materials and methods

Study Design

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Coagulation Studies

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The Biopsy Needle

Biopsy procedure

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After the biopsy

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Result

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Table 1

Analysis of Patients According to the Type of Pathologies

Group 1 ( n = 89) Group 2 ( n = 113) Metastasis 51 54 Hepatocellular carcinoma 29 24 Others 3 28 Insufficient material 6 7 Total 89 113

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Discussion

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Conclusion

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References

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The Importance of Experience in Percutaneous Liver Biopsies Guided with Ultrasonography

Rationale and Objectives

Materials and Methods

Results

Conclusion

Materials and methods

Study Design

Coagulation Studies

The Biopsy Needle

Biopsy procedure

After the biopsy

Result

Discussion

Conclusion

References

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