Experience with transjugular liver biopsy.

Abstract

SUMMARYThe results of 193 transjugular liver biopsies performed with a modified needle are described. An adequate specimen was obtained in 97%, and complications were rare, although puncture of the liver capsule does occur and caused bleeding in two patients. Fever after the procedure was reduced by ultrasonic cleaning of the needle. Although not easy, this technique is safe and preferable in the management of selected patients, but in most patients percutaneous biopsy is to be preferred.Liver biopsy via the internal transjugular vein was first described in 1973' as an extension of transjugular cholangiography. It was advocated in patients with abnormal blood clotting in whom the risk of percutaneous biopsy was unacceptable. The rigidity of the initial modified Ross transeptal needle, however, made biopsy difficult, and histological specimens from patients with cirrhosis often fragmented during aspiration. 1-3 We overcame these disadvantages with a modified Vim-Silverman (Trucut) needle mounted on flexible coaxial cable;4 this resulted in less technical difficulties in obtaining a biopsy, and larger, less fragmented specimens. More recently a modified Menghini needle has been developed with bevelling of the tip to prevent damage to the catheter and reduce compression artefacts of the biopsy specimen.5 We now report our experience of transjugular liver biopsy using our St Thomas' modified needle in 193 patients biopsied during the last three years. Methods PATIENTSThe indications for the transjugular approach are shown in Table 1. Over half were performed because of abnormal blood clotting, usually due to liver disease, but sometimes because patients were receiving anticoagulant drugs.The method has been previously described in detail.

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle

“…Also, the rate of complications may be associated with the experience of the professional performing the procedure (29) . Finally, the clinical status of patients submitted to TJLB is usually worse than that of patients submitted to other forms of biopsy (7,21,23) ; this may have an impact on the incidence of complications. In our study, overall complications occurred in 19% and 22% of the biopsies performed with the trucut and the modified Ross needle, respectively, but the most serious complication consisted of the perforation of the right renal vein (Ross needle) but the patient recovered well after abdominal surgery.…”

“…Many aspects of TJLB have evolved since its initial description, especially in terms of adequate size of specimens for histological diagnosis (7,10,11,14,16) . The most common reason for failure in establishing a histological diagnosis by means of TJLB is fragmentation or small size of the specimens, especially in patients with fibrosis or cirrhosis, when aspiration needles are used.…”

“…However, excessive fragmentation of liver specimens was observed even after the change to a reversed bevel needle and the addition of an inner stylet (10,13,15,23) . A modified version of the percutaneous Vim-Silverman side-cutting needle -the trucut needle -has been proposed for TJLB with the aim of providing larger and less fragmented specimens (7,16,25) . An automated trucut needle, the Quick-Core needle system has also been proposed, and its success rate of histological diagnosis seems to be higher than the modified aspiration Ross needle in patients with suspicion of chronic liver diseases (2,9,12,18,19,20,27) .…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…The core length is significantly shorter in the cartridge (23 %) compared to when removing it out on the tray, and it shrinks (7 %) again when subjected to formalin fixation and paraffin embedding [47]. Issues of smaller sample size and fragmentation problems have been overcome since aspiration techniques have given way to 'Tru-Cut' TJLB methods [48]. Although TJLB specimens yield decreased number of portal tracts, when contrasted with the risk of percutaneous biopsy in those with contraindications, TJLB provides a valuable alternative for assessment of liver histology.…”

Needle Biopsy in Children With Liver Diseases

“…Actually numerous studies strongly suggest that due to the limitations and risks of biopsy, as well as the improvement of the diagnostic accuracy of new noninvasive biomarkers (Fibroscan, FibroTest, ELF) (7)(8)(9)(10)(11)(12)(13)(14), liver biopsy should no longer be considered mandatory as a first line estimate of fibrosis in the most frequent chronic liver diseases. In reality even if the development of non-invasive markers of liver injury must be encouraged especially for the assessment of liver fibrosis, the consensus in many conference statements recommend liver biopsy for the diagnosis and the management of almost all patients with liver diseases (15)(16)(17)(18).…”