CT-guided liver biopsy: an update

Computed tomography (CT)-guided liver biopsy has become an accepted part of the diagnostic evaluation of patients with benign and malignant hepatic disease The advantages of imaging guidance over blind percutaneous biopsy are now well established in the literature. Controversy continues to exist, however, over the safety and accuracy of the procedure, as well as over the proper choice of needle: large-caliber cutting needle versus small caliber aspiration needle. In 1984, our group reported the results in a preliminary set of 180 patients in whom CT-guided biopsy of focal liver lesions was performed. The study indicated that cutting-needle sampling could provide increased diagnostic accuracy over fine-needle aspiration in both benign and malignant hepatic disease without a significant increase in complications. This paper reports the results in a series of 179 new patients who underwent CT-guided liver biopsy using a variety of needles. Comparison is again made between fine-needle and cutting-needle biopsy with respect to diagnostic accuracy and safety. A detailed discussion of the proper choice of biopsy needle as well as of the causes of both biopsy failure and complications is provided.