Safety and efficacy of sonographic-guided random real-time core needle biopsy of the liver.

Purpose: To determine the safety and efficacy of real-time, sonographic-guided, random percutaneous needle biopsy of the liver in a tertiary medical center.

Method: From an IRB-approved biopsy database, all patients who had random liver biopsy performed over a 24-month period were selected. In 350 patients, 539 random percutaneous needle biopsies of the liver were performed under real-time sonographic visualization. The following were recorded from the electronic medical record: patient demographics, indication for biopsy procedure; radiologist's name; needle type and gauge and number of passes; use and amount of i.v. sedation or anesthesia; adequacy of the specimen; and complications following the procedure.

Result: Of 539 biopsies, 378 (70%) biopsy procedures were performed on liver transplant recipients. Of the biopsy procedures in nontransplant patients, 81/161 (50%) concurrently underwent biopsy of a focal liver mass. An 18-gauge automated core biopsy needle was used in 536/539 (99%). Median number of passes per biopsy procedure was 1 (mean, 1.7; range, 1-6). Sedation using midazolam and fentanyl was used in 483/539 (90%). There were only 8 inadequate specimens (1.5%, [2.3, upper 95% confidence limit, fully described in Statistical Analysis]). Complications were identified in 11/539 biopsy procedures (2.0%, [2.6, upper 95% confidence limit]): 5 with severe postprocedural pain, 3 with symptomatic hemorrhage, 2 with infection, and 1 with a rash. There were no sedation-related complications and no deaths related to the procedure.

Conclusion: Real-time, sonographic-guided, random core-needle liver biopsy is a safe and highly effective procedure.