Current liver biopsy practices for suspected parenchymal liver diseases in the United States: the evolving role of radiologists

Abstract

Respondents' chief concern was patient safety, and most used US for this reason. Private practitioners were less likely than those practicing in academic centers to use US guidance and were more likely to refer patients to Radiology.

Trends in the Indication and Method of Liver Biopsy for Hepatitis B and C

“…Our results demonstrate a continuous increase in the proportion of liver biopsies being performed under realtime US-guidance since 1997. This trend is consistent with other studies which show a shift towards liver biopsies being performed under US guidance by either gastroenterologists or radiologists [9,10]. Muir and colleagues, in 2002, reported that nearly half of surveyed gastroenterologists had their patients' liver biopsies performed under US-guidance.…”

“…Seventy-six percent of the respondents used US-guidance to perform liver biopsies; of these 75% reported patient safety as a reason for using US-guidance, and 77% felt that it was unnecessary to perform unguided biopsies. Another reported reason for referral to a radiologist in this survey included a desire for real time ultrasound [10].…”

“…Liver biopsies appear to be increasingly performed under radiologic guidance, particularly with ultrasound (US) marking [6][7][8]. In the United States, radiologists perform most US-guided biopsies [9,10]. Common reasons cited as to why gastroenterologists do not perform blind or unguided biopsies in this country included the involved risks, low reimbursement and logistical issues [9].…”

“…Common reasons cited as to why gastroenterologists do not perform blind or unguided biopsies in this country included the involved risks, low reimbursement and logistical issues [9]. There have also been studies suggesting lower complication rates and higher success rates with US-guidance [10][11][12]. As a result, both the Gastroenterology Core Curriculum and the Accreditation Council for Graduate Medical Education (ACGME) have recently deleted liver biopsy from the list of required procedures for a gastroenterology fellow during their training [13].…”

Controversies in liver biopsy: Who, where, when, how, why?

“…In a recent US survey, 76% of 260 randomly selected members of the American Association for the Study of Liver Diseases (AASLD) reported using ultrasound guidance during liver biopsy, primarily for patient safety; 62% relied on an ultrasonographer to locate and mark the biopsy site; and 18% had the biopsy performed by the radiologist under real-time ultrasound guidance [48]. Members of the Duke University Digestive Epidemiological Studies Consortium were also surveyed; 29.5% of these physicians stated that they did not perform liver biopsies themselves but referred patients to radiologists.…”