Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy

PURPOSE: The efficacy and safety of transjugular liver biopsy used to obtai n liver specimens in patients with coagulation disorders have been widely p roven. However, histopathologic examination is not always possible because of fragmented samples provided by the aspiration technique. Recently, an au tomated device with a Tru-Cut-type needle was designed. In this randomized controlled trial, the use of this new device is compared with the tradition al method in terms of efficacy and safety. METHOD: Fifty-six patients were included in the study; 28 were randomized t o undergo the aspiration technique and 28 were randomized to undergo the au tomated biopsy technique. RESULTS: Correct positioning of the device was achieved in 93% of patients undergoing the aspiration technique and 96% of patients undergoing the auto mated biopsy technique (P = NS). Mean duration of the procedure and total n umber of passes were significantly higher in the aspiration needle group th an in the automated device group (22.6 min +/- 12.6 vs 15.5 min +/- 9.4; P = .03, and 3.3 min +/- 1.9 vs 1.5 min +/- 0.63; P < .001, respectively). Th e number of portal tracts was significantly higher in the automated device group (4.7 +/- 2.5 vs. 2.7 +/- 3.4; P < .05). Adequate specimens for histop athologic evaluation were obtained in 26 patients in the automated device g roup and 24 patients in the aspiration needle group (92.8% vs 85.7%; P = NS ), but a definite histopathologic diagnosis was more frequently obtained wi th the automated biopsy device (68% vs 43%; P = .05). No significant differ ences were observed in complication rates (7.14% vs. 10.7%; P = NS). CONCLUSION: The automated biopsy device for transjugular liver biopsy is mo re effective than an aspiration needle in obtaining good samples for a defi nite histologic diagnosis.