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: 11.34).
04/1999; 30(4):580-7. DOI: 10.1016/S0168-8278(99)80187-1
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.
Available from: Naglaa mohamed Kamal
- "In a prospective study in France, Cadranel et al. 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. 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. 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. 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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ABSTRACT: We aim to investigate the safety of outpatient blind percutaneous liver biopsy (BPLB) in infants and children with chronic liver disease (CLD).
BPLB was performed as an outpatient procedure using the aspiration Menghini technique in 80 infants and children, aged 2 months to 14 yrs, for diagnosis of their CLD. Patients were divided into three groups: Group 1 (<1 year), group 2 (1-6 yrs), and group 3 (6-14 yrs). The vital signs were closely monitored 1 hr before biopsy, and then 1, 2, 6, and 24 hrs after biopsy. Twenty-four hours pre- and post-biopsy complete blood counts, liver enzymes, prothrombin time (PT), and abdominal ultrasonography, searching for a biopsy-induced hematoma, were done for all patients.
No mortality or major morbidities were encountered after BPLB. The rate of minor complications was 17.5% including irritability or "pain" requiring analgesia in 10%, mild fever in 5%, and drowsiness for >6 hrs due to oversedation in 2.5%. There was a statistically significant rise in the 1-hr post-biopsy mean heart and respiratory rates, but the rise was non-significant at 6 and 24 hrs except for group 2 where heart rate and respiratory rates significantly dropped at 24 hrs. No statistically significant difference was noted between the mean pre-biopsy and the 1, 6, and 24-hrs post-biopsy values of blood pressure in all groups. The 24-hrs post-biopsy mean hemoglobin and hematocrit showed a significant decrease, while the 24-hrs post-biopsy mean total leucocyte and platelet counts showed non-significant changes. The 24-hrs post-biopsy mean liver enzymes were non-significantly changed except the 24-hrs post-biopsy mean PT which was found to be significantly prolonged, for a yet unknown reason(s).
Outpatient BPLB performed by the Menghini technique is safe and well tolerated even in infants and young children. Frequent, close monitoring of patients is strongly recommended to achieve optimal patient safety and avoid potential complications.
Available from: Ali Nawaz Khan
- "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. "
- "Although opportunities for further study exist, the available data regarding US guidance show a decreased complication rate, decreased number of passes required, decreased pain and pain-related morbidity, decreased chance of requiring repeat procedure, superior quality of specimens obtained and marginally increased cost, when compared to the blind technique.[126–12] Studies have also shown that the use of US guidance is cost-effective when specimen adequacy and incidence of complications are considered.[6–9] Histological analyses of samples obtained via blind approach indicated biopsy of renal tissue, pericolic fat, and myenteric plexus. "
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ABSTRACT: Liver biopsies are performed for both focal and nonfocal lesions (parenchymal). In our center, majority of liver biopsies are performed for parenchymal liver disease. Parenchymal liver biopsy plays a key role in the diagnosis of various diffuse liver dysfunctions. Results of the biopsy help grade the disease, facilitating prognostication, which helps in planning specific treatment strategies. Imaging guidance is gaining wide acceptance as the standard procedure. Ultrasound (US) guidance is currently considered the most cost-effective and safe way to perform parenchymal liver biopsies. Radiologists worldwide and particularly in the United States are increasingly performing this procedure. Radiologists performing biopsies generally use the cutting needle. Different needle sizes, techniques and preference for biopsy of the right or left lobe have been described. We attribute these preferences to prior training and individual radiologist's comfort level. We describe the algorithm followed at our institution for performing percutaneous US-guided parenchymal liver biopsy. While clinical societies have recommended a minimum of 40 liver biopsies as a requirement for proficiency of clinicians, specific to radiology trainees/fellows interested in pursuing a career in intervention, we feel a total of 20 liver biopsies (includes assisted and independently performed biopsies under supervision) should be adequate training.
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