Sharma Mithun, Lakhtakia Sundeep, Jagtap Nitin, Sekaran Anuradha, Kalapala Rakesh, Jahangeer Basha, Kulkarni Anand, Ramchandani Mohan, Gupta Rajesh, Samudraala Swapna, Khanna Juhi, Nagaraja Padaki, Iyengar Sowmya, Gora Baker Ali, Rao Guduru Venkat, Reddy Nageshwar
Asian Institute of Gastroenterology - Surgical Gastroenterology, Hyderabad, Telangana, India.
Endosc Int Open. 2023 Feb 23;11(2):E172-E178. doi: 10.1055/a-1978-6652. eCollection 2023 Feb.
Percutaneous liver biopsy is traditionally done on the right lobe of the liver. Endoscopic ultrasound-guided liver biopsy (EUS-LB) can be performed on either the left or right lobe or as a combined bi-lobar biopsy. Earlier studies did not compare the benefit of bi-lobar biopsies to single-lobe biopsy for reaching a tissue diagnosis. The current study compared the degree of agreement of pathological diagnosis between the left lobe of the liver compared to right-lobe and with bi-lobar biopsy. Fifty patients fulfilling the inclusion criteria were enrolled in the study. EUS-LB with a 22G core needle was performed separately on both the liver lobes. Three pathologists, who were blinded to the site of biopsy independently reviewed the liver biopsies. Sample adequacy, safety, and concordance of pathological diagnosis between left- and right-lobe biopsy of the liver were analyzed. The pathological diagnosis was made in 96 % of patients. Specimen lengths from the left lobe and the right lobe were 2.31 ± 0.57 cm and 2.28 ± 0.69 cm, respectively ( = 0.476). The respective number of portal tracts were 11.84 ± 6.71 versus 9.58 ± 7.14; = 0.106. Diagnosis between the two lobes showed substantial (κ = 0.830) concordance. Left-lobe (κ value 0.878) and right-lobe (κ = 0.903) biopsies showed no difference when compared with bi-lobar biopsies. Adverse events were observed in two patients, both of whom had biopsies of the right lobe. EUS-guided left-lobe liver biopsy is safer than right-lobe biopsy with similar diagnostic yield.
经皮肝活检传统上是在肝脏右叶进行。内镜超声引导下肝活检（EUS-LB）可在左叶或右叶进行，也可进行双侧联合活检。早期研究未比较双侧活检与单叶活检在获得组织诊断方面的益处。本研究比较了肝左叶与右叶活检以及双侧活检之间病理诊断的一致程度。50名符合纳入标准的患者被纳入研究。使用22G穿刺针分别对两个肝叶进行EUS-LB。三名对活检部位不知情的病理学家独立审查肝活检样本。分析了肝脏左叶和右叶活检样本的充足性、安全性以及病理诊断的一致性。96%的患者做出了病理诊断。左叶和右叶样本长度分别为2.31±0.57cm和2.28±0.69cm（P = 0.476）。门静脉分支数量分别为11.84±6.71和9.58±7.14；P = 0.106。两叶之间的诊断显示出高度一致性（κ = 0.830）。与双侧活检相比，左叶活检（κ值0.878）和右叶活检（κ = 0.903）无差异。两名患者出现不良事件，均为右叶活检。EUS引导下的肝左叶活检比右叶活检更安全，诊断率相似。
