Inspite of the developed laboratory and imaging methods, the importance of liver biopsy in determining the true pathology is indisputable. Nevertheless, it has major disadvantages; it is an invasive method with a risk of complication and there are difficulties in evaluating the biopsy specimen. Biopsy of the liver under US guidance increases the diagnostic yield by obtaining sufficient liver specimen, subsequently increasing the probability of definitive pathological diagnosis (
1, 2, 4, 5, 10, 13). In our series, the overall rates of complications were only 3% and most of them (80.6%) were minor and self-limited. The pain relieved rapidly with no need of analgesia. There was no mortality in the patient population. According to the findings of the wide-scale investigations, the average incidences of mortality and the complications of this procedure are 0.01% and 0.06-0.32%, respectively. In the literature, the US-guided percutaneous liver biopsy reduced post-biopsy pain significantly as well as the need of analgesics. Literature determined that the post-biopsy pain rates are between 5% and 50% ( 2, 4, 5, 8). Our study showed a lower pain and complication rate compared to those reported in the literature.
Even though the liver has a rich vascular supply, complications associated with percutaneous liver biopsy are very rare if the procedure is guided by US. The most frequent major complications of liver biopsy are hemorrhage and biliary leakage. Other complications include hemobilia, organ injuries, arterio-venous fistula and septic shock. Piccinino et al. (
14) investigated 68276 biopsies over 10 years and the major complications were shock, pneumothorax, hemoperitoneum and biliary peritonitis ( 14). In our study, no major complication occurred. In accordance with our study, the most frequent complaint after biopsy was pain at the biopsy site and/or pain over the right shoulder probably due to irritation of the right hemidiaphragm.
According to the literature, cutting needles such as tru-cut needles are associated with a higher complication risk compared to that of aspirating needles because they remain longer inside the liver during the procedure and increase the risk of complications (
15). However, as our study confirmed, US-guided liver biopsy is very safe and effective when carried out by the right hands.
Some studies recommend that the specimen should have a minimum length of 15 mm and should be composed of four to six portal areas; however, other studies suggest that the ideal specimen size should be at least 40 mm in length, and composed of at least two pieces with a minimum of 8 portal areas in each piece (
16, 17). In our study, the average biopsy specimen size was 17 mm and comprised a minimum of 8 portal areas on each piece. Another significant issue is the location of the biopsy, as mentioned. If the biopsy specimen was less than 0.5cm or a necrotic core was obtained, the biopsy was repeated ( 1, 2, 18).
In conclusion, outpatient US-guided percutaneous liver biopsy with tru-cut biopsy needle is a very effective, safe and cost-effective procedure that is principally performed by radiologists. The percutaneous US-guided liver biopsy modality should be applied to all indicated cases by the right hands.