A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy

Abstract

All three needle sizes are safe for use in renal allograft biopsy using a semiautomated biopsy gun. The larger needles provide more tissue and glomeruli and, thus, are more diagnostically useful. Use of a 14G needle may be associated with more pain, and the 16G needle appears to offer the best compromise between diagnostic usefulness and patient acceptability.

Nephrology and the Percutaneous Renal Biopsy

“…The rationale for this is not clear but may be linked to the increasing number of biopsies being done by radiologists as suggested by the study of Tondel et al (28) and as reported by Gupta and Balogun (29), who found that an 18-gauge needle was used in 69% of biopsies performed by radiologists compared with only 14% of biopsies performed by nephrologists. Additionally, the study by Tondel et al (28) and other studies (7,(29)(30)(31)(32) continue to demonstrate that when using an 18-gauge needle, the sample size is significantly smaller (9 versus .12 glomeruli), and often, the quality of the sample (the number of intact glomeruli) is poorer. In the only study assessing the differences between 14-, 16-, and 18-gauge automated needles, Nicholson et al (32) demonstrated that using an 18-gauge needle resulted not only in a significantly smaller sample size (9 versus 11 versus 15 glomeruli) but was also associated with less diagnostic success (53% versus 76% versus 85%), despite no significant differences in complication rates.…”

Arteriovenous Fistula and Pseudoaneurysm: Two Important But Rare Complications of Percutaneous Renal Biopsy and Safety of the 16 G Automated Biopsy Needle

“…The biopsy specimen was signifi cantly better in the 16-G group, with more glomeruli and less artifact. Additionally, a prospective randomized controlled trial using automated needles of 3 different sizes (14,16, and 18 G) in kidney allograft biopsies revealed no difference in complication rates between the 3 sizes, but a higher diagnostic adequacy and more pain in the group with the largest needle (21). The mean number of glomeruli per subject in our study was found as 8.09 ± 1.1 (range=0-86) and was signifi cantly higher by use of automated 16 G needle.…”

Renal Biopsy Interpretation

“…Nowadays, biopsies can be obtained by ultrasound or computed tomography guided (47). The use of biopsy gun, guided by ultrasound has more safety and yield (48,49,50). Each glomerulus has a 200-250 µm diameter, therefore, the needle should be selected properly.…”