Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs

Background/Aims: Our objectives were: (1) to assess the clinical benefits a nd costs of performing ultrasound-guided liver biopsy with an automated nee dle compared to blind biopsy with a conventional Trucut needle in patients with chronic hepatitis C; (2) to compare the histological yield of automate d needles with Trucut needles. Methods: We prospectively studied 166 patients with hepatitis C virus who u nderwent either ultrasound-guided biopsy using automated ASAP needles or bl ind biopsy using conventional Trucut needles. Both groups were matched for age, sex, cirrhosis, needle gauge and operator experience. Patient toleranc e, complications and histological adequacy were assessed. In a separate in vitro study, we assessed the histological adequacy of liver biopsy specimen s obtained using automated and Trucut needles from 10 fresh autopsy cases. Results: Ultrasound-guided biopsy caused significantly less biopsy pain (36 .4% vs. 47.3%; p<0.0001) and significantly less pain-related morbidity (1.8 % vs. 7.7%, p<0.05). Although, there was no significant difference in diagn ostic yield between guided and blind biopsy (98% vs. 94%, p=0.15), 3 blind biopsies (3.3%), including 2 which yielded extra-hepatic tissue, had to be repeated. The additional expense of performing guided liver biopsy with aut omated needles was 42 Irish Pounds per patient. In vitro, automated ASAP 15 G needles provided liver specimens comparable to Trucut 15G needles and had the highest histopathologic score among the automated needles assessed. Conclusions: Even in the absence of major complications, ultrasound-guided liver biopsy with an automated needle in HCV patients is safer, more comfor table and only marginally more expensive than blind Trucut biopsy.