CC BY-NC-ND 4.0 · Endoscopy 2019; 51(11): 1059-1065
DOI: 10.1055/a-0956-6922
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

19 G aspiration needle versus 19 G core biopsy needle for endoscopic ultrasound-guided liver biopsy: a prospective randomized trial

Rafael A. Ching-Companioni
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
David L. Diehl
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Amitpal S. Johal
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Bradley D. Confer
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Harshit S. Khara
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

submitted 17 November 2018

accepted after revision 06 June 2019

Publication Date:
23 July 2019 (online)

Abstract

Background Endoscopic ultrasound-guided liver biopsy (EUS-LB) is a safe and effective method for accomplishing parenchymal liver biopsy. The aim of this study was to compare a 19 G aspiration needle (FNA) with a 19 G Franseen-tip core biopsy needle (FNB) for EUS-LB.

Methods This was a prospective, parallel group, randomized trial comparing the tissue yields and adequacy of a 19 G FNA needle vs. a 19 G FNB needle for EUS-LB. The primary outcome was length of the longest piece of liver core specimen. Secondary outcomes were aggregate specimen length, number of complete portal triads (CPTs), and adverse events. One transgastric pass and one transduodenal pass were performed with the same needle in each patient. Specimen lengths were measured before and after histological processing.

Results 40 patients referred for EUS-LB were randomized to either the FNA group (n = 20) or the FNB group (n = 20). Both groups had similar patient characteristics. FNB biopsies yielded longer mean (standard deviation) specimen lengths (pre-processing mean 2.09 cm [0.41] vs. mean 1.47 cm [0.46], and post-processing mean 1.78 cm [0.66] vs. mean 1.05 cm [0.42]; both P < 0.001), a longer aggregate specimen length (pre-processing mean 15.78 cm [5.19] vs. 10.89 cm [4.38]; P = 0.003), and more CPTs (mean 42.6 [25] vs 18.1 [9.3]; P < 0.001) compared with the FNA needle. There were no severe adverse events or difference in adverse event rate between the two needles. Post-biopsy pain was noted in 37.5 %.

Conclusion EUS-LB using the FNB needle delivered longer liver biopsy specimens with more CPTs than the regular (non-core) needle.

Table 1s , 2s, Fig. 1s – 3s

 
  • References

  • 1 Rockey DC, Caldwell SH, Goodman ZD. et al. Liver biopsy. Hepatology 2009; 49: 1017-1044
  • 2 Rockey DC, Bissell DM. Noninvasive measures of liver fibrosis. Hepatology 2006; 43: S113-S120
  • 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 Parekh PJ, Majithia R, Diehl DL. et al. Endoscopic ultrasound-guided liver biopsy. Endosc Ultrasound 2015; 4: 85-91
  • 6 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
  • 7 Diehl DL, Johal AS, Khara HS. et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open 2015; 3: E1-6
  • 8 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
  • 9 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
  • 10 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
  • 11 Rocken C, Meier H, Klauck S. et al. Large-needle biopsy versus thin-needle biopsy in diagnostic pathology of liver diseases. Liver 2001; 21: 391-397
  • 12 Sey MSL, 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 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
  • 14 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
  • 15 Nieto J, Khaleel H, Challita Y. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified 1-pass, 1 actuation wet suction technique. Gastrointest Endosc 2018; 87: 469-475
  • 16 Mok SRS, Diehl DL, Johal AS. et al. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc 2018; 88: 919-925
  • 17 Schindelin J, Rueden CT, Hiner MC. et al. The ImageJ ecosystem: an open platform for biomedical image analysis. Mol Reprod Dev 2015; 82: 518-529
  • 18 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
  • 19 Mok SR, Diehl DL, Johal AS. et al. Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles. Endosc Int Open 2019; 7: E62-71
  • 20 Attam R, Arain MA, Bloechl SJ. et al. “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 2015; 81: 1401-1407
  • 21 Diehl DL, Mok SRS, Khara HS. et al. Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining. Endosc Int Open 2018; 6: E356-E362
  • 22 DeWitt J, LeBlanc J, McHenry L. et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single center experience. Am J Gastroenterol 2003; 98: 1976-1981
  • 23 Hollerbach S, Willert J, Topalidis T. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: histological and cytological assessment. Endoscopy 2003; 35: 743-749
  • 24 tenBerge J, Hoffman BJ, Hawes RH. et al. EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases. Gastrointest Endosc 2002; 55: 859-862
  • 25 Early DS, Acosta RD, Chandrasekhara V. et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77960: 839-843
  • 26 Eisenberg E, Konopniki M, Veitsman E. et al. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg 2003; 96: 1392-1396
  • 27 Procopet B, Bureau C, Métivier S. et al. Tolerance of liver biopsy in a tertiary care center: comparison of the percutaneous and the transvenous route in 143 prospectively followed patients. Eur J Gastroenterol Hepatol 2012; 24: 1209-1213