How often does ultrasound marking change the liver biopsy site?

OBJECTIVES: The aim of this study was to answer the question: How often doe s ultrasound change the liver biopsy position, when a percussion technique is applied, because of intervening structures? A secondary objective is to compare the performance of the hepatologist to a radiology technician to de monstrate safety of a self-training technique. METHODS: One hundred sixty-five consecutive outpatient liver biopsies were studied. Using a standard percussion technique, a biopsy site was chosen an d marked. Ultrasound was applied to the marked site. An adequate site was d etermined to be one without intervening, structure within 6 cm of liver dep th. If an intervening structure was found, an alternative site was chosen b y ultrasound. Data recorded included reason for change of position, distanc e of moved site from original site, and complications. The first third of l iver biopsies were done with assistance of a certified radiology technician performing ultrasound, the last two-thirds were done by the hepatologist a fter observing the first 64 biopsies. RESULTS: Ultrasound changed the position in 21 of 165 patients. The ultraso und caused an abortion of the procedure: in it of 165 patients. Ultrasound changed management in 15.1%, of patients. Reasons for change were lung (10 patients), gallbladder (6), large central vessel (4), >4-cm rim of ascites (2), colonic loop (I), slim liver edge (1), and focal liver lesions (1 pati ent). There was a 1.8% multiple pass rate. No serious complications occurre d. CONCLUSIONS: Ultrasound changed management 15.1% of patients. A hepatologis t could perform ultrasound marking after a period of observation, without c ompromising results. A low multiple pass rate was observed when applying ul trasound and percussion. Avoided structures could explain decrease in pain when ultrasound is applied. (C) 1999 by Am. Cell. of Gastroenterology.