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Transjugular Liver Core Biopsy: Indications, Results, and Complications
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Dinkel HP, Wittchen K, Hoppe H, Dufour JF, Zimmermann A, Triller J.
Institut fur Diagnostische Radiologie, Inselspital, Universitat Bern, Schweiz.
PURPOSE: To evaluate benefit, feasibility, and frequency of complications with transjugular liver biopsy using a semi-automatic Tru-cut system.
MATERIALS AND METHODS: Eighty-five consecutive patients (57 males, 28 females) with various liver disorders (cirrhosis [30], hepatitis [12], acute hepatopathy [34], orthotopic liver transplantation [8], hepatocellular carcinoma [1]), coagulopathies (n=71) and/or ascites (n = 46) were referred to our department for a transjugular liver biopsy. Mean age was 48 thorn 16 years (range 17 to 75 years). Success and complications were retrospectively evaluated from the radiology reports, pathology reports, and patient files. Success was defined as procuring a tissue specimen that enabled a definite histological diagnosis. The complications included thrombosis at the puncture site, hematoma, cardiac arrhythmia, capsular perforation, hemorrhage, and cardiac damage. Mortality included all deaths within 30 days after the procedure. Procedure-related mortality included all deaths related to the procedure.
RESULTS: The procedure was technically successful in 80 patients (94 %) and unsuccessful in 5 patients (6 %) due to a failed hepatic vein cannulation (1 patient with Budd Chiari syndrome and total liver vein occlusion, 4 patients with unsuitable anatomy). One biopsy pass was made in 22 patients, and two passes were made in 45 and three or more passes in 14 patients, all in a single session. The sample quality was judged by the pathologist as good in 71 of 80 patients (89 %) and poor in 8 patients (10 %). A diagnosis was not possible in 1 patient. Eight procedure-related complications occurred, which were classified according to the criteria of the Society of Interventional Radiology (SIR) as minor in 5 (3 type A, 2 type B) and major in 3 (1 pneumothorax, type C, 1 nonfatal bleeding, type D, and 1 fatal bleeding, type F). Procedure-related mortality was 1 %, overall mortality 15 % (mostly due to progressive liver failure).
CONCLUSION: In patients with coagulopathies, transjugular liver biopsy is a viable alternative for hepatic tissue evaluation with a good sample quality. In a small number of patients severe complications may occur.
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