Article

Guided versus blind liver biopsy for chronic hepatitis C: Clinical benefits and costs

Department of Hepatology, St James's Hospital, Trinity College Dublin, Ireland.
Journal of Hepatology (Impact Factor: 10.4). 04/1999; 30(4):580-7. DOI: 10.1016/S0168-8278(99)80187-1
Source: PubMed

ABSTRACT Our objectives were: (1) to assess the clinical benefits and costs of performing ultrasound-guided liver biopsy with an automated needle compared to blind biopsy with a conventional Trucut needle in patients with chronic hepatitis C; (2) to compare the histological yield of automated needles with Trucut needles.
We prospectively studied 166 patients with hepatitis C virus who underwent either ultrasound-guided biopsy using automated ASAP needles or blind biopsy using conventional Trucut needles. Both groups were matched for age, sex, cirrhosis, needle gauge and operator experience. Patient tolerance, complications and histological adequacy were assessed. In a separate in vitro study, we assessed the histological adequacy of liver biopsy specimens obtained using automated and Trucut needles from 10 fresh autopsy cases.
Ultrasound-guided biopsy caused significantly less biopsy pain (36.4% vs. 47.3%; p < 0.0001) and significantly less pain-related morbidity (1.8% vs. 7.7%, p < 0.05). Although, there was no significant difference in diagnostic yield between guided and blind biopsy (98% vs. 94%, p = 0.15), 3 blind biopsies (3.3%), including 2 which yielded extra-hepatic tissue, had to be repeated. The additional expense of performing guided liver biopsy with automated needles was 42 Irish Pounds per patient. In vitro, automated ASAP 15G needles provided liver specimens comparable to Trucut 15G needles and had the highest histopathologic score among the automated needles assessed.
Even in the absence of major complications, ultrasound-guided liver biopsy with an automated needle in HCV patients is safer, more comfortable and only marginally more expensive than blind Trucut biopsy.

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    • "In a prospective study in France, Cadranel et al.[38] showed that from 2084 liver biopsies, only 56% were echo-guided. Also, many studies showed that the complications of LB seem to be related to the type of the technique, blind, or echo-guided, respectively: (1) Younossi et al.[53] showed that the complications appeared in 4% of the cases with “blind” biopsies and in 2% of the cases with “ultrasound-guided” biopsies (the study revealed the cost-effectiveness of echo-guided biopsy); (2) Farrell et al.[54] showed complications in 1.8% of the cases with “ultrasound-guided” biopsies and in 7.7% of the cases with “blind” biopsies (P<0.05); and (3) Pasha et al.[52] showed that severe complications occurred in 0.5% of the cases with “ultrasound-guided” biopsies and in 2.2% of the cases with “blind” biopsies (P<0.05). The same author revealed that the pain appeared more often (50% of the cases) in the “blind” biopsy group as compared with the “ultrasound-guided” biopsy group (37% of the cases, P=0.003). "
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    • "Indeed, if the pain is due to hepatic friction rub the pain may last for a few weeks (Chuah 1996). The intensity of this pain is mainly mild to moderate(Farrell, et al. 1999, Cadranel, et al. 2000) but can be severe. "
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