Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles

Abstract

Background and study aims Endoscopic ultrasound-guided liver biopsy uses a 19-gauge (G) needle for parenchymal liver biopsies. We evaluated tissue yields with a 22G fine-needle biopsy (FNB) versus 19G FNA fine-needle aspirate (FNA) device.

Patients and methods Biopsies were obtained from 20 patients using the 19G FNA and 22G FNB randomizing each in a cross-over fashion with a blinded outcome assessor. Tissue adequacy for histologic evaluation was the primary outcome, or the proportion of specimens obtaining pathologic diagnosis (portal structures ≥ 5 or length of the longest piece ≥ 15 mm). Additional secondary outcomes included portal and centrilobular inflammation/fibrosis, length of the longest piece, aggregate specimen length, and small (< 5 mm), medium (5 – 8 mm) and large (> 8 mm) fragments. Results were compared in a per needle basis. Patients with cirrhosis were excluded.

Results Eighty biopsies (40 each 19G FNA and 22G FNB) were obtained. Tissue adequacy was greater for the 19G FNA (88 %) versus 22G FNB (68 %), (P = 0.03). There was no difference in total portal structures for the 19G FNA (7.4) and 22G FNB (6.1), (P = 0.28).

There was no difference in pre-processing outcomes. After processing, length of the longest piece was higher for the 19G FNA (9.1 mm) versus 22G FNB (6.6 mm), (P = 0.02). More total post-processing small fragments 29.9 versus 20.7, (P = 0.01) and fewer large fragments 1.0 versus 0.4 for the 22G FNB (P = 0.01) were detected.

Conclusions Tissue adequacy was higher for the 19G FNA versus 22G FNB needle. The 22G FNB needle produced samples more prone to fragmentation during specimen processing.

• References

• 1 Rockey DC, Caldwell SH, Goodman ZD. et al. American Association for the Study of Liver Diseases. Liver biopsy. Hepatology 2009; 49: 1017-1044
• 2 Rockey DC, Bissell DM. Noninvasive measures of liver fibrosis. Hepatology 2006; 43: S113-20
• 3 Rockey DC. Non-invasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008; 134: 8-14
• 4 Ziol M, Handra-Luca A, Kettaneh A. et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005; 41: 48-54
• 5 Sherlock S, Dick R, Van Leeuwen DJ. Liver biopsy today. The Royal Free Hospital experience. J Hepatol 1985; 1: 75-85
• 6 Eisenberg E, Konopniki M, Veitsman E. et al. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg 2003; 96: 1392-1396
• 7 Perrault J, McGill DB, Ott BJ. et al. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology 1978; 74: 103-106
• 8 Stavropoulos SN, Im GY, Jlayer Z. et al. High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction. Gastrointest Endosc 2012; 75: 310-318
• 9 Diehl DL, Johal AS, Khara KS. et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open 2015; 3: E1-E6
• 10 Nakanishi Y, Mneimneh WS, Sey M. et al. One hundred thirteen consecutive transgastric liver biopsies for hepatic parenchymal diseases: a single-institution study. Am J Surg Pathol 2015; 39: 968-976
• 11 Dewitt J, McGreevy K, Cummings O. et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc 2009; 69: 535-542
• 12 Sey MS, Al-Haddad M, Imperiale TF. et al. EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles. Gastrointest Endosc 2016; 83: 347-352
• 13 Pineda JJ, Diehl DL, Miao CL. et al. EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointestinal Endosc 2016; 83: 360-365
• 14 Gleeson FC, Clayton AC, Zhang L. et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease. Clin Gastroenterol Hepatol 2008; 6: 1437-1440
• 15 Gor N, Salem SB, Jakate S. et al. Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle. Gastrointest Endosc 2014; 79: 170-172
• 16 Bhatia V, Hijoka S, Hara K. et al. Endoscopic ultrasound description of liver segmentation and anatomy. Dig Endosc 2014; 26: 482-490
• 17 Sey MS, Al-Haddad M, Imperiale TF. et al. EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles. Gastrointest Endosc 2016; 83: 347-352
• 18 Early DS, Acosta RD, Chandrasekhara V. et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77960: 839-843
• 19 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 20 Firpi RJ, Soldevila-Pico C, Abdelmalek MF. et al. Short recovery time after percutaneous liver biopsy: should we change our current practices?. Clin Gastroenterol Hepatol 2005; 3: 926-929
• 21 Stone MA, Mayberry JF. An audit of ultrasound guided liver biopsies: a need for evidence-based practice. Hepatogastroenterology 1996; 43: 432-434
• 22 McGill DB, Rakela J, Zinsmeister AR. et al. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 1990; 99: 1396-1400
• 23 Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993; 118: 96-98
• 24 Piccinino F, Sagnelli E, Pasquale G. et al. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2: 165-173
• 25 Huang JF, Hsieh MY, Dai CY. et al. The incidence and risks of liver biopsy in non-cirrhotic patients: An evaluation of 3806 biopsies. Gut 2007; 56: 736-737
• 26 Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 2000; 32: 477-481
• 27 Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int 2008; 28: 705-712
• 28 Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495-500
• 29 Lebrec D, Goldfarb G, Degott C. et al. Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure. Gastroenterology 1982; 83: 338-340
• 30 Bull HJ, Gilmore IT, Bradley RD. et al. Experience with transjugular liver biopsy. Gut 1983; 24: 1057-1060
• 31 Schulman AR, Thompson CC, Odze R. et al. Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques. Gastrointest Endosc 2017; 85: 419-426