Targeted and non-targeted liver biopsies carry the same risk of complication

To reappraise the rate of and risk factors for complications of targeted and non-targeted US-guided liver biopsy in a large series.

We analyzed 2405 liver biopsies performed in 2137 patients (58% males, mean age 54 ± 15 years old) between January 2010 and December 2015. Biopsies were performed for focal liver lesions characterization (targeted) or chronic liver disease assessment (non-targeted). Clinical, laboratory, and technical data were recorded. For targeted biopsies, we also recorded the largest diameter, location, enhancement pattern, and pathology. Advert events were divided into marked symptoms and complications. Those requiring specific treatment (embolization or surgery) were considered as severe.

A total of 1283 (53%) targeted and 1122 (47%) non-targeted biopsies were performed. Marked symptoms occurred after 134 biopsies (5.6%) (95 (7.4%) targeted and 39 (3.5%) non-targeted, p < 0.001), the most common being pain (109/134). Complications occurred after 38 biopsies (1.6%) (24 (1.9%) targeted and 14 (1.2%) non-targeted, p = 0.253) and were severe in 13 patients. In univariate analysis, prothrombin time (p = 0.006), serum creatinine level (p < 0.001), largest lesion diameter (p < 0.001), and tumor pathology (p = 0.040) were associated with the occurrence of complications but not platelet count or lesion enhancement pattern. In multivariate analysis, only the largest lesion diameter was retained (OR 1.014 [1.002-1.026], p = 0.018).

The rate of advert events after US-guided liver biopsy was low, with no difference between targeted and non-targeted biopsies. When focusing on targeted biopsies, the largest lesion diameter but not enhancement pattern appeared as the main risk factor.

• Targeted and non-targeted liver biopsies are associated with the same observed risk of complication. • Arterial phase hyperenhanced tumors on contrast-enhanced CT or MRI are not associated with a higher risk of complication when compared with non-hyperenhanced ones. • A high serum creatinine level is associated with a higher risk of complication and should motivate strict post-biopsy surveillance.