Image-Guided Liver Biopsy: Perspectives from Interventional Radiology

Jingqin Ma; Qian Yu; Thuong Van Ha

doi:10.1055/s-0044-1792174

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2024; 41(05): 500-506
DOI: 10.1055/s-0044-1792174

Review Article

Image-Guided Liver Biopsy: Perspectives from Interventional Radiology

Jingqin Ma

¹Department of Interventional Radiology, Shanghai Medical School of Fudan University, Zhongshan Hospital, Shanghai, People's Republic of China

,

Qian Yu

²Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois

,

Thuong Van Ha

²Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois

› Author Affiliations

Abstract

Liver biopsy is a crucial aspect of interventional radiology and plays a significant role in the management of hepatobiliary diseases. Radiologists commonly perform two major image-guided liver biopsy techniques: percutaneous and transjugular approaches. It is essential for radiologists to understand the role of liver biopsy in diagnosing and treating hepatobiliary conditions, the procedural details involved, and how to manage potential complications. This article reviews the indications, contraindications, techniques, and efficacy of image-guided liver biopsy, with a focus on both percutaneous and transjugular methods.

Keywords

interventional radiology - liver biopsy - ultrasound - percutaneous - transjugular liver biopsy

Full Text

References

References
1 Peeraphatdit TB, Wang J, Odenwald MA, Hu S, Hart J, Charlton MR. Hepatotoxicity from immune checkpoint inhibitors: a systematic review and management recommendation. Hepatology 2020; 72 (01) 315-329
2 Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR. Practice Parameters Committee of the American College of Gastroenterology. ACG Clinical Guideline: diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol 2021; 116 (05) 878-898
3 Lohse AW, Sebode M, Bhathal PS. et al. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology. Liver Int 2022; 42 (05) 1058-1069
4 Tan D, Goodman ZD. Liver biopsy in primary biliary cholangitis: indications and interpretation. Clin Liver Dis 2018; 22 (03) 579-588
5 Khalifa A, Rockey DC. The utility of liver biopsy in 2020. Curr Opin Gastroenterol 2020; 36 (03) 184-191
6 Khalifa A, Sasso R, Rockey DC. Role of liver biopsy in assessment of radiologically identified liver masses. Dig Dis Sci 2022; 67 (01) 337-343
7 Abraldes JG, Araujo IK, Turón F, Berzigotti A. Diagnosing and monitoring cirrhosis: liver biopsy, hepatic venous pressure gradient and elastography. Gastroenterol Hepatol 2012; 35 (07) 488-495
8 Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. American Association for the Study of Liver Diseases. Liver biopsy. Hepatology 2009; 49 (03) 1017-1044
9 Germani G, Hytiroglou P, Fotiadu A, Burroughs AK, Dhillon AP. Assessment of fibrosis and cirrhosis in liver biopsies: an update. Semin Liver Dis 2011; 31 (01) 82-90
10 Chowdhury AB, Mehta KJ. Liver biopsy for assessment of chronic liver diseases: a synopsis. Clin Exp Med 2023; 23 (02) 273-285
11 Bosch J, Chung C, Carrasco-Zevallos OM. et al. A machine learning approach to liver histological evaluation predicts clinically significant portal hypertension in NASH cirrhosis. Hepatology 2021; 74 (06) 3146-3160
12 Haber PK, Castet F, Torres-Martin M. et al. Molecular markers of response to anti-PD1 therapy in advanced hepatocellular carcinoma. Gastroenterology 2023; 164 (01) 72-88.e18
13 Rastogi A. Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma. World J Gastroenterol 2018; 24 (35) 4000-4013
14 Chan SL, Wong N, Lam WKJ, Kuang M. Personalized treatment for hepatocellular carcinoma: current status and future perspectives. J Gastroenterol Hepatol 2022; 37 (07) 1197-1206
15 Shetty S, Adams DH, Hubscher SG. Post-transplant liver biopsy and the immune response: lessons for the clinician. Expert Rev Clin Immunol 2012; 8 (07) 645-661
16 Rodríguez-Perálvarez M, Rico-Juri JM, Tsochatzis E, Burra P, De la Mata M, Lerut J. Biopsy-proven acute cellular rejection as an efficacy endpoint of randomized trials in liver transplantation: a systematic review and critical appraisal. Transpl Int 2016; 29 (09) 961-973
17 Rastogi A. Liver transplant biopsy interpretation: diagnostic considerations and conundrums. Indian J Pathol Microbiol 2022; 65 (02) 245-257
18 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
19 Kitchin DR, Del Rio AM, Woods M, Ludeman L, Hinshaw JL. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol (NY) 2018; 43 (06) 1494-1501
20 Scheuer PJ. Liver biopsy size matters in chronic hepatitis: bigger is better. Hepatology 2003; 38 (06) 1356-1358
21 Mulazzani L, Terzi E, Casadei G. et al. Retrospective analysis of safety of ultrasound-guided percutaneous liver biopsy in the 21st century. Eur J Gastroenterol Hepatol 2021; 33 (1S, Suppl 1): e355-e362
22 Krokidis M, Hungerbühler M, Hewer E, Heverhagen J, von Tengg-Kobligk H. Ex vivo performance comparison of three percutaneous biopsy needle systems. Eur Radiol 2019; 29 (08) 4044-4049
23 Agarwal AN, Nania J, Qiu L, Lewis B, Mais DD. Impact of liver biopsy size on histopathologic evaluation of liver allograft rejection. Arch Pathol Lab Med 2022; 146 (12) 1530-1534
24 Giri S, Agrawal D, Gopan A, Varghese J, Tripathy T. Diagnostic outcome and safety of plugged liver biopsy in high-risk patients: a systematic review and meta-analysis. Acta Radiol 2023; 64 (05) 1775-1782
25 Riley SA, Ellis WR, Irving HC, Lintott DJ, Axon AT, Losowsky MS. Percutaneous liver biopsy with plugging of needle track: a safe method for use in patients with impaired coagulation. Lancet 1984; 2 (8400): 436
26 Singhal S, M D P, Inuganti S, Botcha S, Deepashree DT, Uthappa MC. Percutaneous ultrasound-guided plugged liver biopsy - a single-centre experience. Pol J Radiol 2021; 86: e239-e245
27 Handke NA, Koch DC, Muschler E. et al. Bleeding management in computed tomography-guided liver biopsies by biopsy tract plugging with gelatin sponge slurry. Sci Rep 2021; 11 (01) 24506
28 Wilsen CB, Patel MK, Douek ML. et al. Contrast-enhanced ultrasound for abdominal image-guided procedures. Abdom Radiol (NY) 2023; 48 (04) 1438-1453
29 Russell G, Strnad BS, Ludwig DR. et al. Contrast-enhanced ultrasound for image-guided procedures. Tech Vasc Interv Radiol 2023; 26 (03) 100913
30 Francica G, Meloni MF, de Sio I. et al. Biopsy of liver target lesions under contrast-enhanced ultrasound guidance - a multi-center study. Ultraschall Med 2018; 39 (04) 448-453
31 Hoffmann P, Cyrany J, Kopecky J. et al. Percutaneous CT-guided biopsy of focal liver lesions - long- term experience with more than 300 procedures. J Gastrointestin Liver Dis 2023; 32 (02) 197-205
32 Schmidt VF, Öcal O, Walther V. et al. Clinical benefits of MRI-guided freehand biopsy of small focal liver lesions in comparison to CT guidance. Eur Radiol 2024; 34 (09) 5507-5516
33 Ahn SJ, Lee JM, Chang W. et al. Clinical utility of real-time ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions. Eur J Radiol 2018; 103: 76-83
34 Bodard S, Guinebert S. N Petre E, et al. Percutaneous liver interventions with robotic systems: a systematic review of available clinical solutions. Br J Radiol 2023; 96 (1152): 20230620
35 Stift J, Semmler G, Walzel C. et al. Transjugular aspiration liver biopsy performed by hepatologists trained in HVPG measurements is safe and provides important diagnostic information. Dig Liver Dis 2019; 51 (08) 1144-1151
36 Eichholz JC, Kirstein MM, Book T, Wedemeyer H, Voigtländer T. Transjugular liver biopsy and hepatic venous pressure gradient measurement in patients with and without liver cirrhosis. Eur J Gastroenterol Hepatol 2021; 33 (12) 1582-1587
37 Zhang H, Wang Z, Wei X. et al. Hepatic venous pressure gradient evaluates the Scheuer stage of liver fibrosis by transjugular liver biopsy: a multicenter study. HPB (Oxford) 2023; 25 (06) 644-649
38 Vu T, Eberly H, Zheng A. et al. Clinical significance of measuring hepatic venous pressure gradient on transjugular liver biopsy for patients with pre-cirrhotic bridging fibrosis liver disease. Clin Imaging 2023; 96: 44-48
39 Borquez AA, Silva-Sepulveda J, Lee JW. et al. Transjugular liver biopsy for Fontan associated liver disease surveillance: technique, outcomes and hemodynamic correlation. Int J Cardiol 2021; 328: 83-88
40 Lal BB, Sood V, Rastogi A. et al. Safety, feasibility, yield, diagnostic and prognostic implications of transjugular liver biopsy in children and adolescents. J Pediatr Gastroenterol Nutr 2021; 73 (05) e109-e114
41 Smayra K, Miangul S, Yap N. et al. Technical success, sample adequacy, and complications of pediatric transjugular liver biopsy: a systematic review and meta-analysis. Dig Dis Sci 2023; 68 (10) 3846-3856
42 Bhogal N, Lamb B, Arbeiter B. et al. Safety and adequacy of endoscopic ultrasound-guided random liver biopsy in comparison with transjugular and percutaneous approaches. Endosc Int Open 2020; 8 (12) E1850-E1854
43 Kalambokis G, Manousou P, Vibhakorn S. et al. Transjugular liver biopsy – indications, adequacy, quality of specimens, and complications – a systematic review. J Hepatol 2007; 47 (02) 284-294
44 Lee EW, Sue MJ, Saab S. et al. Accuracy and safety of 1,055 transjugular liver biopsies in postliver transplant patients. Clin Transl Gastroenterol 2021; 12 (05) e00355
45 Cholongitas E, Quaglia A, Samonakis D. et al. Transjugular liver biopsy: How good is it for accurate histological interpretation?. Gut 2006; 55 (12) 1789-1794
46 Mohan BP, Shakhatreh M, Garg R, Ponnada S, Adler DG. Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89 (02) 238-246.e3
47 Madhok IK, Parsa N, Nieto JM. Endoscopic ultrasound-guided liver biopsy. Clin Liver Dis 2022; 26 (01) 127-138
48 Mok SRS, Diehl DL. The role of EUS in liver biopsy. Curr Gastroenterol Rep 2019; 21 (02) 6
49 Facciorusso A, Crinò SF, Ramai D. et al. Diagnostic yield of endoscopic ultrasound-guided liver biopsy in comparison to percutaneous liver biopsy: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16 (01) 51-57
50 Midia M, Odedra D, Shuster A, Midia R, Muir J. Predictors of bleeding complications following percutaneous image-guided liver biopsy: a scoping review. Diagn Interv Radiol 2019; 25 (01) 71-80
51 Lavian JD, Thornton LM, Zybulewski A. et al. Safety of percutaneous versus transjugular liver biopsy: a propensity score matched analysis. Eur J Radiol 2020; 133: 109399
52 Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Dig Dis Sci 1981; 26 (05) 388-393
53 Witters P, Freson K, Verslype C. et al. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther 2008; 27 (11) 1017-1029
54 Sasso R, Khalifa A, Guimaraes M, Rockey DC. Comparison of the safety of transjugular and percutaneous liver biopsies. J Vasc Interv Radiol 2023; 34 (12) 2120-2127.e2
55 Schiano TD, Azeem S, Bodian CA. et al. Importance of specimen size in accurate needle liver biopsy evaluation of patients with chronic hepatitis C. Clin Gastroenterol Hepatol 2005; 3 (09) 930-935
56 Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003; 39 (02) 239-244