Clinical

Transjugular liver biopsy provides adequate tissue for diagnosis

Last Updated: 2006-12-05 12:55:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Liver biopsies obtained via the jugular vein provide adequate tissue to make a histological diagnosis, according to a report in the December issue of Gut.

Many consider transjugular liver biopsy (TJLB) to be inferior to percutaneous liver biopsy, the authors explain, because TJLB is more likely to provide more fragmented and thinner samples.

Dr. Andrew Burroughs and colleagues from Royal Free Hospital, London, UK evaluated length, fragmentation, and number of portal tracts in 326 consecutive TJLB specimens and audited sample adequacy in relation to recently proposed standards for diagnosing, grading, and staging chronic hepatitis.

All TJLB attempts succeeded in obtaining liver samples using three passes, the researchers report, and the specimen was adequate for histological diagnosis in all but 1.5% of samples. There were no major complications from the procedure.

The median total length of samples was 22 mm, with a median 5 fragments, the results indicate. Nearly 90% of the specimens were at least 15 mm long, 65% were at least 20 mm long, and 36% were at least 25 mm long.

The median number of total portal tracts was 13, the researchers note, 8 of which were complete and 5 of which were partial.

By comparison, percutaneous liver biopsy specimens had a median total length of 17 mm and a median of 7 complete portal tracts, which did not differ significantly from TJLB specimens.

"The characteristics of our TJLB with three passes are better than those obtained by the average percutaneous liver biopsy reported in the literature," the investigators conclude.

"TJLB has some intrinsic characteristics that paradoxically could make it a more appropriate technique for liver biopsy, obtaining optimal specimens even with the current standards," the researchers add. "Multiple cores can be obtained, in contrast with percutaneous liver biopsy in which more than one pass causes increased complications. In TJLB, provided the liver capsule is not punctured (does not occur with experienced operators), complications do not increase with multiple passes."

Gut 2006;55:1789-1794.