Contribution, Indications and Technical Realization of Ultrasound-guided Liver Biopsy

Abstract

The liver biopsy (LB) still keeps some indications today, in spite of the progress of the non-invasive explorations. Several LB techniques have been studied. Some techniques use medical imaging. These techniques also differ in the material used to collect the hepatic sample. This study aimed to determine the current indications of LB, the interest using ultrasound guidance and an automatic device in order to improve its performance and its contribution to the diagnosis. This was a retrospective study including percutaneous LB performed under ultrasound guidance using automatic system equipped with a sharp needle. The study involved 50 patients with 26 diffuse liver diseases (DLD) and 24 focal liver lesions (FLL). The indications for DLD biopsy were dominated by suspicion of hepatic sarcoidosis, primary biliary cirrhosis and hepatic tuberculosis. FLL were dominated by the exploration of nodules or masses. The number of passes made was three in 96% of cases, otherwise it was four, with an average size of 1.3 cm for cores. DLD were dominated by chronic liver disease (42%), granulomatous hepatitis (23%), steatohepatitis (11%) and primary biliary cirrhosis (8%). FLL were dominated by secondary malignancies (46%) and primary malignant lesions (25%). For FLL, LB sensitivity, specificity, positive predictive value and negative predictive value were respectively 81%, 100%, 100% and 20%. LB confirmed 45% of DLD diagnoses, when they were well oriented by clinical and paraclinical data. The LB allowed to rectify the diagnosis in 54% of cases. When no initial diagnosis was suspected, LB enabled a specific diagnosis in 75% of cases. Major complications were void in our study. In conclusion, the use of ultrasound guidance and an automatic device with a sharp needle has increased the number of passes, improved the quality of sampling and reduced complications.