Liver biopsy: ultrasonography guidance is not superior to the blind method

The aim of this study was to evaluate our experience with adequate liver biopsy samples and compare the complication rates of blind and US-guided biopsies, as well as to compare the histological yield of blind and US-guided biopsy specimens.

We retrospectively analyzed 205 consecutive patients that underwent liver biopsies during a 12-month period. Liver biopsy was performed via the blind method in 152 patients, and via US-guidance in 53 patients. Biopsy specimens were evaluated according to length, presence of fragmentation, crush artifacts, adequacy for diagnosis, and the number of portal tracts and central veins. We also evaluated the rates of mortality and major life-threatening complications.

All the biopsy specimens were adequate for histological evaluation, except in 8 cases, of which 4 were in the blind biopsy group (2.63%) and 4 were in the US-guided biopsy group (7.54%) (P>0.05). There were no statistically significant differences between the two groups in terms of the specimen fragmentation, or number of portal tracts and central veins in each specimen. Mean specimen length in the US-guided liver biopsy group was 12.58+/-5.59 mm, and in the blind biopsy group 16.22+/-9.91 mm (P<0.005) . There was no mortality or major complications in either of the two study groups.

US-guided biopsy was not superior to blind biopsy, an unexpected result. Gastroenterologists/hepatologists should be encouraged to perform liver biopsies via the blind method.