Comparison of the diagnostic quality of aspiration and core-biopsy needles for transjugular liver biopsy

Aim Liver biopsy remains essential for diagnostic work-up of patients with liver disease. Here we compared aspiration vs. core-biopsy needles for transjugular liver biopsy (TJLB) in patients undergoing hepatic venous pressure gradient (HVPG) measurements in regard to the diagnostic value of the obtained samples

Methods 84 patients undergoing TJLB between 06/2017-12/2018 were prospectively included. Liver biopsy specimens were systematically evaluated for quantitative and qualitative criteria such as number of portal tracts (PT), sample length and fragmentation. These quality parameters of liver biopsy specimens obtained by aspiration needle vs. core-biopsy needle were compared, including sub-groups of patients stratified according to liver stiffness measurements (LSM) and HVPG.

Results In direct comparison of paired TJLB specimens, core-biopsy samples were significantly longer (median 12 vs. 9mm, p = 0.012), tended to contain more PT (median 8 vs. 6, p = 0.064) and were less fragmented (p < 0.001), which resulted in better confidence for liver fibrosis assessment (p = 0.035). However, a superior quality in terms of less fragmentation of core-biopsy specimens (p < 0.05) was only confirmed in patients with HVPG ≥ 10mmHg or LSM  > 40kPa. In contrast, the aspiration needle provided significantly longer samples in patients with HVPG  < 10mmHg (median 21 vs. 12mm, p = 0.007) or with LSM  < 20kPa (median 21 vs. 11mm, p = 0.025).

Conclusions In patients with HVPG ≥ 10mmHg or LSM  > 40kPa TJLB should be performed by core-biopsy needles, while the aspiration needle provides high quality liver biopsy specimens in patients with HVPG  < 10mmHg or LSM  < 20kPa.

Publication History

Article published online:
26 May 2020