Abstract
Recently, it has been shown that transjugular liver biopsy (TJLB) with three passes gives comparable specimens to percutaneous liver biopsy (PLB). The aim of this study was to evaluate the adequacy of TJLB using four passes in a consecutive series of patients, and whether using a supportive cassette can prevent fragmentation. One hundred consecutive TJLBs in 92 patients (48 transplanted), always using four passes (19-G Tru-Cut), were compared to three-pass TJLBs. The four-pass TJLB specimens were randomized at a 1:1 ratio of liver cores placed in a cassette versus not. The four-pass TJLBs, compared to three-pass TJLBs, resulted in better specimens for length (≥25 mm: 50% vs. 35%; p = 0.026) and number of complete portal tracts (CPTs) (≥11: 40% vs. 26%; p = 0.027), without a higher complication rate. The four-pass TJLB with ≥11 CPTs had a median length of 27 mm, and 57% of them longer than 28 mm contained ≥11 CPTs. Putting the liver biopsy cores into a cassette did not improve the fragmentation rate or adequacy of the specimen (length and number of CPTs) of TJLB. We conclude that at least four passes with TJLB should be performed when liver specimens are needed for grading and staging. Using a supportive cassette did not reduce fragmentation.
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References
Kalambokis G, Manousou P, Vibhakom S et al (2007) Transjugular liver biopsy—indications, adequacy, quality of specimens, and complications—a systematic review. J Hepatol 47:284–294
Bravo AA, Sheth SG, Chopra S (2001) Liver biopsy. N Engl J Med 344(7):495–500
Lebrec D (1996) Various approaches to obtaining liver tissue—choosing the biopsy technique. J Hepatol 25(Suppl 1):20–24
Blasco A, Forns X, Carrion JA et al (2006) Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology 43(3):492–499
Cholongitas E, Quaglia A, Samonakis D et al (2006) Transjugular liver biopsy: how good it is for accurate histological interpretation? Gut 55(12):1789–1794
Miraglia R, Luca A, Gruttadauria S et al (2006) Contribution of transjugular liver biopsy in patients with the clinical presentation of acute liver failure. CardioVasc Interv Radiol 29:1008–1010
Donaldson B, Gopinath R, Wanless I et al (1993) The role of transjugular liver biopsy in fulminant liver failure: relation to other prognostic indicators. Hepatology 18:1370–1376
Dawson M, McCarthy P, Walsh M et al (2005) Transjugular liver biopsy is a safe and effective intervention to guide management for patients with a congenital bleeding disorder infected with hepatitis C. Intern Med J 35:556–559
Shin JL, Teitel J, Swain MG et al (2005) A Canadian multicenter retrospective study evaluating transjugular liver biopsy in patients with congenital bleeding disorders and hepatitis C: is it safe and useful? Am J Hematol 78(2):85–93
See TC, Thompson BC, Howie AJ et al (2008) Transjugular renal biopsy: our experience and technical considerations. CardioVasc Interv Radiol (in press)
Guido M, Rugge M (2004) Liver biopsy sampling in chronic viral hepatitis. Semin Liver Dis 24(1):89–97
Cholongitas E, Senzolo M, Standish R et al (2006) A systematic review of the quality of liver biopsy specimens. Am J Clin Pathol 125(5):710–721
Colloredo G, Guido M, Sonzogni A, Leandro G (2003) Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 39(2):239–244
Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38(6):1449–1457
Grant A, Neuberger J (1999) Guidelines on the use of liver biopsy in clinical practice. Br Soc Gastroenterol Gut 45(Suppl 4):IV1–IV11
Papatheodoridis GV, Patch D, Watkinson A, Tibballs J, Burroughs AK (1999) Transjugular liver biopsy in the 1990s: a 2-year audit. Aliment Pharmacol Ther 13(5):603–608
Cholongitas E, Quaglia A, Samonakis D et al (2007) Transjugular liver biopsy in patients with diffuse liver disease: comparison of 3 cores with 1 or 2 cores for accurate histological interpretation. Liver Int 27(5):646–653
Crawford AR, Lin XZ, Crawford JM (1998) The normal adult human liver biopsy: a quantitative reference standard. Hepatology 28(2):323–331
Sawyerr AM, McCormick PA, Tennyson GS et al (1993) A comparison of transjugular and plugged-percutaneous liver biopsy in patients with impaired coagulation. J Hepatol 17(1):81–85
Campbell MS, Reddy KR (2004) Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther 20(3):249–259
Alessandria C, Debernardi-Venon W, Rizzetto M et al (2007) Transjugular liver biopsy: a relatively simple procedure with an indefinite past and an expected brilliant future. J Hepatol 48:171–172
Smith TP, Presson TL, Heneghan MA et al (2003) Transjugular biopsy of the liver in pediatric and adult patients using an 18-gauge automated core biopsy needle: a retrospective review of 410 consecutive procedures. Am J Roentgenol 180(1):167–172
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Vibhakorn, S., Cholongitas, E., Kalambokis, G. et al. A Comparison of Four- Versus Three-Pass Transjugular Biopsy Using a 19-G Tru-Cut Needle and a Randomized Study Using a Cassette to Prevent Biopsy Fragmentation. Cardiovasc Intervent Radiol 32, 508–513 (2009). https://doi.org/10.1007/s00270-008-9412-7
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DOI: https://doi.org/10.1007/s00270-008-9412-7