Safety and efficacy of percutaneous CT-guided liver biopsy using an 18-gauge automated needle

BACKGROUND: Computed tomography (CT)-guided liver biopsy using large-caliber cutting needles allows the recovery of larger tissue specimens that are more suitable for establishing histological diagnosis. Yet, large-caliber needles are associated with higher rates of post-biopsy bleeding. The aim of this prospective study was to assess the efficacy and safety of the method, when all of the procedures were performed by experienced radiologists and all patients were carefully evaluated and treated, when needed, before the biopsy. METHODS: A total of 767 consecutive patients with focal hepatic lesions underwent CT-guided liver biopsy during a 5-year period. The procedures were performed in a single center using 18-gauge automated biopsy guns with a 2-cm cutting edge by a team of experienced radiologists (>100 procedures performed by each one before the initiation of the study). Before the procedure, abnormal coagulation indices were corrected, ascites was treated and, in all cases, an adequate parenchymal cuff of normal tissue between the lesion and the capsule was retained. RESULTS: In all cases the extracted specimens were adequate for diagnosis. No major complications (i.e., death or complications requiring surgery, chest tube, or blood transfusions) were observed. Minor complications (i.e., those not requiring medical intervention) were observed in three patients. CONCLUSIONS: Percutaneous CT-guided liver biopsy using an 18-gauge automated needle is a safe and effective procedure. Careful pre-biopsy evaluation and treatment, when needed, and maintenance of an adequate parenchymal cuff between the lesion and the capsule contribute to the safety of the method.