Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

Abstract

Background/Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an effective and safe method of procuring liver tissue. The aims of this study were to assess and compare the outcomes and tissue adequacy of a single-pass, single-actuation, wet suction technique between 19 G and 22 G needles in patients undergoing EUS-LB.Methods: We performed a prospective case series study of 20 patients undergoing EUS-LB at a single center between September 2017 and April 2020. The primary objective was to evaluate differences in sample adequacy via a single actuation wet suction technique between a 19 G core needle and a 22 G core needle. Adequacy was gauged by cumulative core biopsy length and the number of portal tracts visualized.Results: The 19 G needle provided a longer core length (2.5 cm vs. 1.2 cm, p<0.0001), more complete portal tracts (5.8 vs. 1.7, p<0.0001), more total tracts (8.8 vs. 3, p<0.0001), and a longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). The 19 G needle was superior in providing adequate (60% vs. 5%, p<0.001) and diagnostic pathologic samples (85% vs. 10%, p<0.001).Conclusions: A single-pass, single-actuation, wet suction technique using a 19 G needle is superior to that using a 22 G needle for tissue acquisition and sample adequacy in EUS-LB.

EUS-guided left lobe liver biopsy: Safer modality with similar diagnostic yield as right lobe: a pilot study

“…When a comparison is made between EUS-LB with the standard of care percutaneous liver biopsy, a previous study by Bhogal et al found no difference between specimens from liver biopsy obtained by either method as regards the length of the longest piece and the number of portal tracts, although the tissue length was longer in percutaneous liver biopsy 27 . Similar studies have found similar diagnostic accuracy between EUS-LB (88.8 %) and percutaneous liver biopsy sample (100 %) ( P = 0.82) 28 . Therefore, it has been found that EUS-LB specimens are at least comparable to percutaneous liver biopsy specimens with a benefit to sample widely separated liver segments 14 .…”

“…Recent studies with 19Gz needle for EUS guided liver biopsy has shown longer core length ( 2.5 cms vs 1.2 cms, p <0.00001) with more portal tracts (8.8 vs. 3, p<0.0001), and longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). [28] The major strength of the study was that the pathologists were blinded about the tissue sample and three separate pathologists were independently involved in the diagnosis. In addition, the EUS-LB was done by 3 operators that avoided bias.…”

“…[27] Similar studies have found that similar diagnostic accuracy between EUS liver guided liver biopsy (88.8%) and percutaneous liver biopsy sample (100%) (p = 0.82). [28] Therefore, it has been found that EUS guided liver biopsy specimens are at least comparable to percutaneous liver biopsy specimen with a benefit to sample widely separated liver segments. [14].…”

Update on endoscopic ultrasound-guided liver biopsy

“…The researchers posit that the 22 G samples had greater fragmentation, leading to reduced intact specimen length and CPT, reducing histological adequacy. The advantage of 19 G compared to 22 G needle was also shown in core needles, where 19 G core needles had a greater CPT (8.8 vs 3, P < 0.0001), longer core length (2.5 cm vs 1.1 cm, P < 0.0001), and a higher rate of pathological diagnostic samples (85% vs 10%, P < 0.0001) when compared to 22 G core needles[ 35 ].…”

Diagnostic and interventional EUS in hepatology: An updated review

“…[ 7 8 9 ] Regarding the size of needle, emerging evidence suggests that 19 G needles are better than 22 G needles as several studies have reported higher tissue fragmentation and lesser adequate specimen with latter. [ 10 11 12 13 14 ] Recent randomized clinical trial (RCT) ( n = 40) comparing the tissue yields and adequacy of a 19 G FNA versus 19 G Franseen-tip core biopsy FNB needle for EUS-LB demonstrated longer LB specimen and more CPT with EUS FNB needle without any serious adverse events. [ 15 ]…”