Sonazoid-Enhanced Ultrasonography Guidance Improves the Quality of Pathological Diagnosis in the Biopsy of Focal Hepatic Lesions

Abstract

Contrast-enhanced ultrasonography (US) using second-generation contrast agent Sonazoid has improved the detection and characterization of focal hepatic lesions. We evaluated the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing accuracy of histopathological diagnosis between B-mode US and SEUS guidance. This retrospective study included 140 focal hepatic lesions in 127 patients (mean age; 63.6 years) referred for US-guided percutaneous biopsy between April 2012 and September 2016. The diagnostic accuracy of the biopsy was defined as the percentage of the total number of lesions clearly diagnosed at the initial biopsy. A case was considered a technical failure when pathological results failed to specifically indicate final diagnosis owing to insufficient material or when pathological results changed from benign to malignant by re-biopsy. Among 140 focal hepatic lesions, 57 lesions underwent biopsy with B-mode US guidance while 83 received SEUS guidance. Patient characteristics (sex, age, lesion location and diameter, and reasons for biopsy) did not differ significantly between groups. Diagnostic accuracy was significantly higher under SEUS guidance than B-mode US guidance (91.6% vs. 75.4%, respectively; p < 0.05). When biopsies were performed to diagnose or rule out malignancy in indeterminate focal hepatic lesions, diagnostic accuracy was also significantly higher under SEUS guidance than B-mode US guidance (100% vs. 70.8%, respectively; p < 0.05). SEUS guidance resulted in a significantly higher rate of successful single-puncture attempts during biopsy procedures than B-mode US guidance (53.0% vs. 35.1%, respectively; p < 0.05). SEUS guidance improves the accuracy of hepatic tumor biopsy pathological diagnosis compared to B-mode US guidance. SEUS guidance is recommended for more accurate localization of suitable hepatic lesion biopsy areas since it increases conspicuity and differentiates viable area from denaturalization or necrosis.