[Show abstract][Hide abstract] ABSTRACT: Most medical liver biopsies in the UK are now taken in radiology departments using 18 g biopsy needles. Subjectively, the resulting biopsies are narrow and fragile.
To compare the quality of liver biopsy tissue sections obtained from 16 and 18 g biopsy needles.
Fifty consecutive routine medical liver biopsies obtained with 16 and 18 g needles, processed identically in the same laboratory, were measured using digital pathology software. We recorded their fragmentation, length, width, area and number of portal tracts.
Biopsies obtained with 16 g needles more often resulted in an intact core in tissue sections than those with 18 g needles (71% vs 24%, p<0.001) and were significantly wider (average width of tissue 0.88 vs 0.53 mm, p<0.001). The average total area of tissue per pass was 11.38 mm(2) compared with 8.34 mm(2) (p<0.001). The number of complete portal tracts per length of biopsy was very variable, but double for 16 vs 18 g biopsies. Routinely taking two passes with the 18 g needle compensated for the reduced area, but the resulting liver in tissue sections was fragmented and distorted.
Our results support the routine use of 16 g rather than 18 g biopsy needles for routine ultrasound-guided medical liver biopsies. A second pass should be considered if the first biopsy core is short, especially for investigation of disease stage.
[Show abstract][Hide abstract] ABSTRACT: Image-guided hepatic biopsies have been performed safely and accurately for a number of years. The advantages of sonographic or CT guidance in avoiding major vital structures, such as large vessels, the gallbladder, or pleura, have been confirmed many times. However, the safety and accuracy of certified nurse practitioners' performing these biopsies have not been described. The authors describe a retrospective review of 418 image-guided hepatic biopsies that demonstrated no significant difference in accuracy or complication rates between biopsies performed by certified nurse practitioners and those performed by radiologists in a single-institution, multihospital academic setting. Appropriately trained advanced practice providers can perform image-guided hepatic biopsies safely and accurately.
Journal of the American College of Radiology: JACR 05/2014; 11(11). DOI:10.1016/j.jacr.2014.03.021 · 2.84 Impact Factor
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