A Comparative Analysis of Endoscopic Ultrasound Guided Fine Needle Liver Biopsy (EUS-FNLB) with Percutaneous and Transjugular Liver Biopsy Specimens; Where Do We Stand?

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Lab Invest

Abstract

Background: Liver biopsy provides the most specific assessment of liver disease with the most common method being the percutaneous liver biopsy (PCLB) technique. The transjugular liver biopsy (TJLB) is preferred in patients with coagulopathy, ascites or when portal pressure gradient measurements are required. With the development high yield needles, endoscopic ultrasoundguided fine needle liver biopsy (EUS-FNLB) has re-emerged as an alternative. While some criteria have been proposed, there is not currently consensus criteria to determine an adequate LB for EUS-FNLB. As such, the aim of this study is to evaluate a cohort of EUS-FNLB specimens with a focus on adequacy and ability to issue a diagnosis. Design: We reviewed a total of 46 EUS-FNLB cases collected at our institution between April 2022 and August 2023. Relevant clinical and histologic parameters were recorded. All cases were reviewed by at least 2 of 5 our liver pathologists prior to sign-out. Histopathologic parameters were collected on 24 TJLB and 40 PCLB cases, collected in the same time period, for comparison. Chisquare and Fisher’s exact tests were used for data analysis. Results: Out of 46 EUS-FNLB cases, the most common indication for EUS-FNLB was to evaluate for fibrosis and measure portal pressure gradients (98%). The average number of portal tracts was 44 with a mean aggregate length of 6 cm (compared to 14 and 1.8 cm for PCLB; and 14.5 and 2.3 for TJLB). The mean length of the largest fragment was 1 cm (compared to 1.1 cm for PCLB; and 1 cm for TJLB). Biopsy cores were fragmented in 37 (80%) cases. In contrast, 9 of 40 (22%) PCLB and 10 of 24 (42%) of TJLB specimens with fragmentation. The average number of tissue fragments was 19 (range 2-58) and the average number of fragments with a minimum of 3 portal tracts was 5 (range 2-27). In 7 (15%) cases, evaluation was reported as limited by fragmentation. In the PC and TJ LB specimens, 98% and 92% were reported as sufficient for evaluation. Conclusions: Our results show comparable specimen adequacy between EUS-FNLB, PCLB and TJLB with significantly more portal tracts and longer aggregate specimen length with EUS-FNLB (P <0.05). As expected, even with high yield needle technology, the main limitation was tissue fragmentation (P <0.05). Despite this, definitive assessment was possible for 85% of cases. This is comparable to 98% of PCLB and 92% of TJLB specimens. Our data demonstrate that adequate specimens can be collected by EUS-FNLB and diagnoses can be rendered with confidence.

Volume

104

Issue

3

First Page

S1701

Last Page

S1702

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