Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Korean J Radiol. 2024 Oct;25(10):902-912. doi: 10.3348/kjr.2024.0536.
The increasing utilization of various molecular tests for diagnosing and selecting treatments for patients with malignancies has led to a rising trend in both the frequency of biopsies and the required tissue volume. We aimed to compare the safety of outpatient ultrasound (US)-guided percutaneous liver biopsy (PLB) between the coaxial method with needle track plugging (NTP) and the conventional method.
This single-center, prospective, randomized controlled study was conducted from October 2022 to May 2023. Patients referred for US-guided PLB with target liver lesions measuring ≥1 cm and requiring ≥3 tissue cores were enrolled. Patients with severe coagulopathy or a substantial volume of ascites were excluded. Patients were randomly assigned to undergo PLB using either the coaxial method with NTP or the conventional method, in a 1:1 ratio, and were subsequently discharged after 2 hours. The primary endpoint was the presence of a patent track sign, defined as a linear color flow along the biopsy track on Doppler US, as an indication of bleeding. The secondary endpoints included clinically significant bleeding, delayed bleeding after discharge, and diagnostic yield. The incidences of these endpoints were compared between the two methods.
A total of 107 patients completed the study protocol. Patent track signs were observed significantly less frequently in the coaxial method with NTP group than in the conventional method group: 16.7% (9/54) vs. 35.8% (19/53; = 0.042). Clinically significant bleeding and delayed bleeding did not occur in either group, and both methods achieved a high diagnostic yield: 94.4% (51/54) vs. 98.1% (52/53; = 0.624).
Compared with the conventional method, the coaxial method with NTP may potentially be safer, with a reduced risk of overall bleeding complications after PLB when retrieving ≥3 tissue cores. The coaxial method with NTP could be considered a viable option for acquiring multiple liver tissues on an outpatient basis.
各种用于诊断和选择恶性肿瘤患者治疗方法的分子检测的应用日益增多，导致活检的频率和所需组织量都呈上升趋势。本研究旨在比较同轴法联合针道封堵（NTP）与传统方法行超声引导经皮肝活检（PLB）的安全性。
这是一项单中心、前瞻性、随机对照研究，于 2022 年 10 月至 2023 年 5 月进行。纳入因目标肝病灶直径≥1cm 且需获取≥3 个组织芯而接受超声引导 PLB 的患者。排除严重凝血功能障碍或大量腹水的患者。患者以 1:1 的比例随机分为同轴法联合 NTP 组或传统方法组，2 小时后出院。主要终点为线性彩色血流沿活检道显示，即多普勒超声上的“针道显影”，提示出血。次要终点包括临床显著出血、出院后延迟出血和诊断率。比较两种方法的这些终点的发生率。
共 107 例患者完成研究方案。同轴法联合 NTP 组的针道显影发生率明显低于传统方法组：16.7%（9/54）比 35.8%（19/53）（ = 0.042）。两组均未发生临床显著出血和延迟出血，两种方法的诊断率均较高：94.4%（51/54）比 98.1%（52/53）（ = 0.624）。
与传统方法相比，同轴法联合 NTP 在获取≥3 个组织芯时，PLB 后总体出血并发症的风险可能较低，安全性更高。同轴法联合 NTP 可作为一种可行的选择，用于在门诊获取多个肝组织。
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