Transjugular liver biopsy – Indications, adequacy, quality of specimens, and complications – A systematic review

• Published in: Journal of hepatology 2007-08, Vol.47 (2), p.284-294
• Main Authors: Kalambokis, George, Manousou, Pinelopi, Vibhakorn, Shusang, Marelli, Laura, Cholongitas, Evangelos, Senzolo, Marco, Patch, David, Burroughs, Andrew K
• Format: Article
• Language: English
• Subjects: Abdomen; Biological and medical sciences; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; Biopsy, Needle - standards; Cardiac dysrhythmias; Cardiology. Vascular system; Complications; Digestive system; Fragmentation; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Heart; Humans; Indications; Investigative techniques, diagnostic techniques (general aspects); Jugular Veins; Liver - pathology; Medical sciences; Menghini; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Quality; Transjugular liver biopsy; Tru-Cut
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2007.05.001

Transjugular liver biopsy (TJLB) is considered an inferior biopsy, used when percutaneous liver biopsy (PLB) is contraindicated. According to recent literature, specimens with ⩾6 complete portal tracts (CPTs) are needed for histological diagnosis of chronic liver disease but ⩾11 CPTs to reliably stage and grade. Mean CPT number in PLB series is 7.5; more passes increase complications. Sixty-four series reporting 7649 TJLBs were evaluated for quality of specimen and safety. Major indications were coagulation disorders and/or ascites. Success rate was 96.8%. Fragmentation rate was 34.3%, not correlating with length or diagnostic adequacy. With a mean of 2.7 passes, mean CPT number was 6.8. Histological diagnosis was achieved in 96.1% of TJLBs, correlating with length ( p = 0.007) and CPT number ( p = 0.04). Tru-Cut specimens had a mean CPT number of 7.5 and, compared to Menghini specimens, were longer ( p < 0.008), less fragmented ( p < 0.001) and more diagnostic ( p < 0.001). Thinner needles (>16-G) provided significantly longer and less fragmented specimens. Minor and major complication rates were 6.5% and 0.56%, respectively, and increased in children, but not with additional passes. In adults, mortality was 0.09% (haemorrhage 0.06%; ventricular arrhythmia 0.03%). TJLB is safe, providing specimens qualitatively comparable to PLB, and may improve further using ⩾18-G Tru-Cut needle and >3 passes.