THE ROLE OF ULTRASONOGRAPHY AND AUTOMATIC-NEEDLE BIOPSY IN OUTPATIENTPERCUTANEOUS LIVER-BIOPSY

The risk of complications from percutaneous liver biopsy is low, but d iscomfort is common and complications require hospitalization in appro ximately 4% of patients. The optimal method of performing these biopsi es is unknown. The goal of our study was to determine whether the use of ultrasonography in the biopsy room immediately prior to or during t he procedure would lessen the risk of complications and to compare the safety and efficacy in obtaining tissue by use of a Trucut needle ver sus an automatic biopsy needle. Between 1992 and 1994 836 patients wer e entered into a randomized study (489 in Rochester, MN; 347 in Barcel ona, Spain). Patients were randomized immediately prior to liver biops y into four groups: Trucut needle, or automatic biopsy needle, and wit h or without ultrasonography. Fisher's Exact Test and a logistic regre ssion model were also used to assess the effect of needle and ultrason ography on the odds for complications. The four biopsy groups were wel l-matched at entry with respect to age, sex, underlying liver disease, hemoglobin, prothrombin time, and platelet count. The use of ultrasou nd was associated with a decreased rate of hospitalization for pain, h ypotension, or bleeding (2 vs. 9, P < .05). No difference in safety wa s found between the two types of needles. The number of passes needed to obtain specimens was similar for all four groups. The average lengt h of the specimen was slightly greater with ultrasonographic-guided bi opsies (1.7 mm vs. 1.6 mm, P < .05) and with biopsies obtained using t he automatic biopsy needle when compared with the Trucut needle (1.7 m m vs. 1.5 mm, P < .05), but this did not seem to be clinically importa nt. The addition of ultrasonography reduces complications in patients undergoing percutaneous liver biopsy. The type of needle appears to of fer little difference in safety or yield of diagnostic tissue, The use of ultrasonography for guidance of percutaneous liver biopsy will lea d to a lower rate of complications. The value of this benefit must be weighed against the added cost of ultrasonographic guidance.