Research Report
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World J Gastrointest Pathophysiol. May 15, 2014; 5(2): 114-119
Published online May 15, 2014. doi: 10.4291/wjgp.v5.i2.114
Liver biopsy: Analysis of results of two specialist teams
Giulia Anania, Elia Gigante, Matteo Piciucchi, Emanuela Pilozzi, Eugenio Pucci, Adriano Maria Pellicelli, Carlo Capotondi, Michele Rossi, Flavia Baccini, Giulio Antonelli, Paola Begini, Gianfranco Delle Fave, Massimo Marignani
Giulia Anania, Elia Gigante, Matteo Piciucchi, Flavia Baccini, Giulio Antonelli, Paola Begini, Gianfranco Delle Fave, Massimo Marignani, Department of Digestive and Liver Disease, School of Medicine and Psychology University “Sapienza”, 00189 Rome, Italy
Emanuela Pilozzi, Eugenio Pucci, Department of Pathology, School of Medicine and Psychology University “Sapienza” Azienda Ospedaliera, 00189 Rome, Italy
Adriano Maria Pellicelli, Liver Unit, Azienda Ospedaliera San Camillo, 000149 Rome, Italy
Carlo Capotondi, Michele Rossi, Department of Radiology, School of Medicine and Psychology University “Sapienza” Azienda Ospedaliera, 00189 Rome, Italy
Author contributions: Anania G, Gigante E, Antonelli G and Marignani M performed the research; Capotondi C, Rossi M, Baccini F, Begini P and Marignani M performed the procedures; Pilozzi E and Pucci E performed the histological analysis; Anania G, Gigante E, Piciucchi M, Begini P and Marignani M analyzed the data; Marignani M, Pellicelli AM and Delle Fave G drafted the paper; Anania G, Gigante E, Piciucchi M and Marignani M wrote the paper.
Correspondence to: Massimo Marignani, MD, Department of Digestive and Liver Disease, Biliary Tract and Liver Disease Section, School of Medicine and Psychology University “Sapienza”, Azienda Ospedaliera Sant’Andrea, Via Grottarossa, 1035-1039, 00189 Rome, Italy. mmarignani@hotmail.com
Telephone: +39-6-33775691 Fax: +39-6-33775526
Received: September 11, 2013
Revised: December 20, 2013
Accepted: January 17, 2014
Published online: May 15, 2014
Processing time: 251 Days and 1.2 Hours
Abstract

AIM: To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams.

METHODS: Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy was assessed by a revision performed by a single pathologist unaware of the previous pathology report. Clinical, laboratory and demographic patient characteristics, the adverse events rate and the diagnostic adequacy of LB were analyzed.

RESULTS: During the study period, 226 patients, 126 males (56%) and 100 females (44%), underwent LB: 167 (74%) were carried out by the G team, whereas 59 (26%) by the IR team. LB was mostly performed in a day hospital setting by the G team, while IR completed more procedures on inpatients (P < 0.0001). The groups did not differ in median age, body mass index (BMI), presence of comorbidities and coagulation parameters. Complications occurred in 26 patients (16 G team vs 10 IR team, P = 0.15). Most gross samples obtained were considered suitable for basal histological evaluation, with no difference among the two teams (96.4% G team vs 91.5% IR, P = 0.16). However, the samples obtained by the G team had a higher mean number of portal tracts (G team 9.5 ± 4.8; range 1-29 vs IR team 7.8 ± 4.1; range 1-20) (P = 0.0192) and a longer mean length (G team 22 mm ± 8.8 vs IR team 15 ± 6.5 mm) (P = 0.0001).

CONCLUSION: LB can be performed with similar outcomes both by G and IR. Use of larger dimension needles allows obtaining better samples, with a similar rate of adverse events.

Keywords: Liver biopsy; Ultrasound-guided biopsy; Ultrasound-assisted biopsy; Menghini needle; Sample adequacy; Portal tracts.

Core tip: Gastroenterologists and interventional radiologists are equally proficient in performing liver biopsy, both in a day hospital and regular admission setting, even with different techniques used (ultrasound-guided and ultrasound-assisted). However, a biopsy performed with larger needles provides better samples for histopathological evaluation, with no increase of morbidity or mortality rates compared to those obtained using needles of smaller size.