Accuracy of endoscopic ultrasound-guided biopsy of focal liver lesions

Abstract

Aim: Endoscopic ultrasound (EUS) has become an indispensable method for diagnosis in gastroenterology and new indications for EUS continue to emerge. However, there are limited data regarding the accuracy of EUS-guided biopsy of hepatic focal lesions. The aim of this study was to assess the diagnostic yield of EUS-guided fine needle aspiration (FNA) of focal liver lesions.Material and methods: We conducted a prospective study in which patients with focal liver lesions, detected by transabdominal ultrasound and computed tomography or magnetic resonance imaging, underwent EUS-guided FNA to determine the diagnostic yield of the procedure.Results: In 47/48 of patients, the results of EUS-FNA were positive for malignancy, while in one case the acquired fragment was insufficient for appropriate histological analysis. Diagnostic yield was 0.98. In 83% of the cases biopsies were taken from the left lobe and in 17% from the right lobe with the same technical success rate. The most common diagnosis was metastatic adenocarcinoma of the pancreas (26% cases) followed by cholangiocarcinoma (17% cases). Concurrent sampling of other sites in addition to the liver and/or primary tumor was realized in 35% of the cases, with results that correlated with the liver biopsy and with the primary tumor biopsy. We reported no immediate or long-term complications in any of the patients.Conclusions: EUS guided fine needle aspiration/biopsy of focal liver lesions is safe, provides a very high diagnostic accuracy and should not be considered only as a rescue method after failure of percutaneous guided biopsies.

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

“…46 47 In the biopsy of focal liver lesions, image guidance, with either real time US, CT or MRI, is a necessity to place the needle accurately at the site of the lesion and obtain a relevant sample with a high degree of accuracy. 48 Real-time US has also been used in conjunction with fusion imaging to enable successful biopsy of focal lesions not readily visible on B-mode ultrasound. 49 If operators wish to do 'blind biopsies', we recommend that this is done only when an ultrasound has been done to exclude anatomical and other variants that may affect the optimal site for liver biopsy.…”

A Comprehensive Narrative Review on the Evolving Role of Endoscopic Ultrasound in Focal Solid Liver Lesions Diagnosis and Management

“…The EUS transducer proximity to the liver enables the endosonographer to perform a precise and accurate imaging study of the liver. Additionally, given the transducer proximity to the organ of interest, EUS can easily identify intervening structures and vessels, thus minimizing the rate of EUS-related adverse events, if fine needle aspiration (FNA) is planned [3,4]. Other advantages include the EUS ability to provide real-time elastography (RTE) and real-time doppler and contrast-enhanced (CE) images, which improve the diagnostic performance in the focal lesion [5] by providing semi-quantitative measurements of focal lesion stiffness and the vascular component of the lesion as recognized by color images [6,7].…”

“…Frequently, to reach an exact diagnosis of focal liver lesions, additional specific imaging modalities, aspiration, biopsy, or combinations are needed. Elucidating the exact nature of these focal lesions is of tremendous significance as this may impact the management, stage, and prognosis [4]. In fact, the advantages of EUS discussed above enable practitioners to reach the precise diagnosis.…”

“…The role of EUS in the diagnosis of focal liver lesions has been mainly investigated in metastatic liver lesions and early hepatocellular carcinoma (HCC) [9][10][11]. The superiority of EUS over the other conventional imaging modalities (US, CT, and MRI) has been shown primarily in the detection of focal liver lesions of less than 1 cm [4,12,13], proposing EUS as an important imaging tool in suspected small liver metastasis in the setting of other primary malignancies. To date, few studies have been published in this field.…”

“…Most of the biopsies were taken from the left lobe (83%), while 17% were taken from the right lobe with similar technical success rate and without any reported immediate long-term complications. They concluded that EUS-FNA/FNB of focal liver lesions is highly accurate and safe and should not be limited only to cases of failure of percutaneous guided biopsies [4]. Recently, new fork-tip end-cutting needles have been evaluated in pancreatic solid lesions.…”