1 Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA 15213.
2 Department of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
AJR Am J Roentgenol. 2018 Jan;210(1):183-188. doi: 10.2214/AJR.17.17792. Epub 2017 Nov 1.
An American Association for the Study of Liver Diseases (AASLD) consensus document stressed the importance of obtaining sufficient liver biopsy specimens to minimize sampling errors. Many centers continue to use smaller-diameter core systems to minimize perceived complication risks. The objective of this study was to assess the impact of core gauge (18- vs 16-gauge) on specimen adequacy and procedural complications.
One hundred fifty patients referred for liver biopsy were randomized to undergo 16- or 18-gauge ultrasound (US)-guided core biopsy. Hemorrhage was qualitatively evaluated, and pain was assessed using a 10-point rating scale. The length and number of portal tracts per specimen were assessed. On the basis of the AASLD guidelines, specimen adequacy was defined as 11 or more portal tracts. Differences in pathology metrics and pain scoring were assessed using chi-square and linear regression models.
No significant hemorrhage occurred in either group, and there was no difference in postbiopsy pain scores. The mean specimen length obtained with 16-gauge needles was less than that obtained with 18-gauge needles (1.7 vs 1.9 cm, p = 0.03). The mean number of portal tracts obtained with 16-gauge biopsies was greater than obtained with 18-gauge systems (14 vs 13, p = 0.03); 85% of 16-gauge biopsy specimens and 80% of 18-gauge biopsy specimens were adequate on the basis of the AASLD criteria, although this difference was not statistically significant.
US-guided 18- and 16-gauge core biopsies are similarly safe. A large percentage of 18- or 16-gauge specimens are inadequate when AASLD quality control adequacy thresholds are applied, and specimen adequacy is not significantly affected by biopsy gauge.
美国肝病研究学会 (AASLD) 的一份共识文件强调了获取足够肝活检样本以最大限度减少采样误差的重要性。许多中心继续使用较小直径的核心系统来最小化感知到的并发症风险。本研究的目的是评估核心测径器（18 号与 16 号）对标本充足性和程序并发症的影响。
150 名因肝活检而就诊的患者被随机分为 16 号或 18 号超声 (US) 引导的核心活检组。定性评估出血情况，并使用 10 分制评分评估疼痛。评估每个标本的门静脉道长度和数量。根据 AASLD 指南，标本充足性定义为 11 个或更多门静脉道。使用卡方和线性回归模型评估病理学指标和疼痛评分的差异。
两组均未发生明显出血，且活检后疼痛评分无差异。16 号针获得的标本平均长度小于 18 号针（1.7 与 1.9 cm，p = 0.03）。16 号活检获得的门静脉道数量多于 18 号系统（14 与 13，p = 0.03）；根据 AASLD 标准，85%的 16 号活检标本和 80%的 18 号活检标本是充足的，尽管这一差异没有统计学意义。
US 引导的 18 号和 16 号核心活检同样安全。当应用 AASLD 质量控制充足性标准时，大量 18 号或 16 号标本不充足，活检测径器对标本充足性没有显著影响。
