Liver biopsy in cirrhotic patients

Liver biopsy remains an important tool for the evaluation of patients with hepatic disease. However, clinicians utilize a variety of biopsy techniques including automated cutting needle devices, manual cutting needles, and aspiration needles. Using a large study cohort of patients with advanced fibrosis/cirrhosis we sought to evaluate practices and outcomes of the biopsy technique used by study investigators across the United States. All biopsy samples were from patients with suspected advanced fibrosis or cirrhosis because of hepatitis C virus (HCV) infection. Individual study investigators were permitted to use any biopsy technique. Biopsy specimens were centrally evaluated for tissue adequacy and fragmentation, and were histologically scored using accepted criteria. We evaluated a total of 923 liver biopsy specimens from 502 patients performed at 62 clinical sites. The average duration of HCV infection was 27.9 +/- 0.46 yr. Automated cutting needles were significantly more likely to provide adequate specimens for evaluation than aspiration needles (P < 0.005). Automated cutting needles produced significantly longer biopsies than other techniques (P < 0.05), except for a limited number of cases in which a surgical wedge biopsy was obtained. Tissue fragmentation was observed in 39.2% of liver biopsies obtained using an aspiration technique, but in only 4.7% of samples collected using an automated cutting needle (P < 0.001). We conclude that automated cutting needles provide superior liver biopsy specimens compared with aspiration techniques in subjects with advanced fibrosis/cirrhosis. No specific safety issues attributable to a particular biopsy method were identified.