Liver fibrosis: how many samples in transjugular liver biopsy are sufficient? Histological vs. clinical value

Liver biopsy (LB) is a diagnostic procedure to obtain histological diagnosis, grading and staging in individuals with liver diseases. Most commonly LB is performed percutaneously. However, transjugular liver biopsy (TJLB) is considered as an alternative. The aim of this prospective study was to evaluate the diagnostic accuracy of TJLB.

TJLB with a semi-automatic Tru-Cut System (18G) was performed in 39 patients with various liver diseases (21 females and 18 males; age range 11-77 years). The number of complete portal tracts (CPTs), lengths and numbers of acquired cores, number of performed cutting steps (passes), and the possibility to obtain histological diagnosis were analyzed.

There were no procedure-related complications, and in total 45 procedures were performed. Diagnosis could be established in 88.8 % of all samples, in five cases histology yielded no diagnosis due to an inadequate number of CPTs or sample fragmentation. In average, 4 passes were performed and 4 (range 1-7) cores were obtained. Median core length was 1.1 cm (range 0.4-1.9 cm), median number of CPTs was 7 (range 0-20). Liver fibrosis in general led to a decreased number of CPTs (p < 0.05).

TJLB is a safe procedure allowing histological diagnosis of liver diseases. In our cohort, performing 4 cutting procedures during TJLB resulted in a sufficiently high specimen quality, particularly in individuals with liver cirrhosis.