Ultrasound-Guided Liver Biopsy: Single Center Experiences

Abstract

Objectives: The aim of this study was to investigate the safety and efficiency of ultrasound-guided tru-cut liver biopsy (US-TLB) for grading liver fibrosis in patients with chronic hepatitis. Materials and Methods: Between June 2016 and June 2021, patients who underwent US-TLB were reviewed retrospectively. Patients’ demographics, biopsy indication, and complication rates were noted. The efficiency of the biopsy was determined according to the adequacy of the tissue sample. Re-biopsy was considered as inefficient biopsy. Massive bleeding, pneumothorax and death were determined as major complications. Other complications were noted as minor complications. The relationship between morbidity and mortality rates, complication rates and biopsy indications were investigated. Results: A total of 1195 liver parenchymal biopsies were performed in 1143 patients. Major complication rate was 0.16% (n=2) and minor complication rate was 6.1% (n=73). Major complications were massive abdominal bleeding at the rate of 0.08% (n=1) and pneumothorax at the rate of 0.08% (n=1). Minor complications were pain at the biopsy site requiring medication in 3.2% (n=39), self-limiting subcapsular hematoma not requiring transfusion in 2.1% (n=26), and syncope in 0.6% (n=8), respectively. US-TLB effectiveness was 95.5%. There was no mortality. Conclusion: To grade the liver fibrosis of patients with chronic hepatitis, adequate pathological specimens can be obtained with high success rates in US-TLB. US-TLB is a safe and effective method in patients with chronic hepatitis.

Keywords

• Liver Biopsy
• Complication Rates
• Tru-Cut Biopsy

Ultrason Kılavuzluğunda Karaciğer Biyopsisi: Tek Merkez Deneyimleri

Abstract

Amaç: Bu çalışmanın amacı, kronik hepatitli hastalarda karaciğer fibrozisini derecelendirmek için ultrason eşliğinde tru-cut karaciğer biyopsisinin (US-TKB) güvenliğini ve etkinliğini araştırmaktı. Gereç ve Yöntem: Haziran 2016-Haziran 2021 tarihleri arasında US-TKB yapılan hastalar geriye dönük olarak incelendi. Hastaların demografik özellikleri, biyopsi endikasyonu, komplikasyon oranları not edildi. Biyopsinin etkinliği doku örneğinin yeterliliğine göre belirlendi. Yeniden biyopsi, yetersiz biyopsi olarak kabul edildi. Masif kanama, pnömotoraks ve ölüm majör komplikasyonlar olarak belirlendi. Diğer komplikasyonlar minör komplikasyon olarak not edildi. Morbidite ve mortalite oranları, komplikasyon oranları ve biyopsi endikasyonları arasındaki ilişki araştırıldı. Bulgular: Toplam 1143 hastada 1195 karaciğer parankim biyopsisi yapıldı. Majör komplikasyon oranı %0,16 (n=2), minör komplikasyon oranı %6,1 (n=73) idi. Majör komplikasyonlar masif abdominal kanama %0,08 (n=1) ve pnömotoraks %0,08 (n=1) idi. Minör komplikasyonlar sırası ile %3,2 (n=39) oranında biyopsi sahasında medikasyon gerektiren ağrı, %2,1 (n=26) oranında transfüzyon gerektirmeyen kendini sınırlayan subkapsüler hematom ve %0,6 (n=8) oranında senkop idi. US-TKB efektivitesi %95,5 idi. Mortalite yoktu. Sonuç: Kronik hepatitli hastaların karaciğer fibrozisini derecelendirmek için yapılan US-TKB’de yüksek başarı oranları ile yeterli patolojik spesmen elde edilebilmektedir. US-TKB kronik hepatitli hastalarda güvenli ve etkin bir yöntemdir.

Keywords

• Karaciğer Biyopsisi
• Komplikasyon Oranları
• Tru-Cut Biyopsi

References

1. 1. Tian G, Kong D, Jiang T, et al. Complications After Percutaneous Ultrasound- Guided Liver Biopsy: A Systematic Review and Meta-analysis of a Population of More Than 12,000 Patients From 51 Cohort Studies. J Ultrasound Med. 2020;39:1355-1365.
2. 2. Rockey DC, Caldwell SH, Goodman ZD, et al. Liver biopsy. Hepatology. 2009;49:1017-1044.
3. 3. Khalifa A, Rockey DC. The utility of liver biopsy in 2020. Curr Opin Gastroenterol. 2020;36:184-191.
4. 4. Neuberger J, Patel J, Caldwell H, et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut. 2020;69:1382-1403.
5. 5. Veltri A, Bargellini I, Giorgi L, et al. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol. 2017;40:1501-1513.
6. 6. Sun Y, Zhou J, Wang L, et al. New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment. Hepatology. 2017;65:1438-1450.
7. 7. Al Knawy B, Shiffman M. Percutaneous liver biopsy in clinical practice. Liver Int. 2007;27:1166-1173.
8. 8. Patel IJ, Davidson JC, Nikolic B, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727-736.

9. 9. Chang Y, Kim JI, Lee B, et al. Clinical application of ultrasonography-guided percutaneous liver biopsy and its safety over 18 years. Clin Mol Hepatol. 2020;26:318-327.
10. 10. Özkan H. Epidemiology of Chronic Hepatitis B in Turkey. Euroasian J Hepatogastroenterol. 2018;8:73-74.
11. 11. Gurol E, Saban C, Oral O, et al. Trends in hepatitis B and hepatitis C virus among blood donors over 16 years in Turkey. Eur J Epidemiol. 2006;21:299-305.
12. 12. Nobili V, Comparcola D, Sartorelli MR, et al. Blind and ultrasound-guided percutaneous liver biopsy in children. Pediatr Radiol. 2003;33:772-775.
13. 13. Takyar V, Etzion O, Heller T, et al. Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience. Aliment Pharmacol Ther. 2017;45:744-53.
14. 14. Chi H, Hansen BE, Tang WY, et al. Multiple biopsy passes and the risk of complications of percutaneous liver biopsy. Eur J Gastroenterol Hepatol. 2017;29:36-41.
15. 15. Patel IJ, Rahim S, Davidson JC, et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 2019;30:1168-1184.e1.
16. 16. Hadi M, Walker C, Desborough M, et al. CIRSE Standards of Practice on Perioperative Anticoagulation Management During Interventional Radiology Procedures. Cardiovasc Intervent Radiol. 2021;44:523-536.
17. 17. Boyum JH, Atwell TD, Schmit GD, et al. Incidence and Risk Factors for Adverse Events Related to Image-Guided Liver Biopsy. Mayo Clin Proc. 2016;91:329-335.
18. 18. Potretzke TA, Saling LJ, Middleton WD, et al. Bleeding Complications After Percutaneous Liver Biopsy: Do Subcapsular Lesions Pose a Higher Risk? AJR Am J Roentgenol. 2018;211:204-210.
19. 19. Ateş ÖF, Taydaş O, Kara AB, et al. A new predictor of bleeding based on ultrasonographic features in percutaneous liver mass biopsy. Turk J Med Sci. 2020;50:1970-1975.
20. 20. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495- 500.
21. 21. West J, Card TR. Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology. 2010;139:1230-1237.,
22. 22. Thomaides-Brears HB, Alkhouri N, Allende D, et al. Incidence of Complications from Percutaneous Biopsy in Chronic Liver Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2021 Jun 15.,
23. 23. van der Poorten D, Kwok A, Lam T, et al. Twenty-year audit of percutaneous liver biopsy in a major