Abstract：
BACKGROUND: Ultrasound-guided percutaneous liver biopsy is considered the technique of choice for the histological diagnosis of space-occupying lesions, given its high level of safety and diagnostic performance. However, since it is an invasive diagnostic procedure, complications can occur. Various clinical and radiological parameters have been analysed as factors related with the efficacy of the technique or with its complications; however, the results have been contradictory. Thus, we aimed to evaluate the impact of various risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy in the diagnosis of space-occupying lesions in ordinary clinical practice.
METHODS: This retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analysed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin >100mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analysed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analysed in terms of the percentage of complications, which were classified as major or minor.
RESULTS: We included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalised patients, and 65% of the lesions were located in the right liver lobe. The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (P=.04).
CONCLUSIONS: Ultrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.
METHODS: This retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analysed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin >100mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analysed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analysed in terms of the percentage of complications, which were classified as major or minor.
RESULTS: We included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalised patients, and 65% of the lesions were located in the right liver lobe. The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (P=.04).
CONCLUSIONS: Ultrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.
摘要：
背景：超声引导下经皮肝穿刺活检被认为是占位性病变组织学诊断的首选技术，鉴于其高水平的安全性和诊断性能。然而,因为这是一种侵入性诊断程序，可能发生并发症。已分析了各种临床和放射学参数，作为与该技术的功效或其并发症相关的因素；然而，结果是矛盾的。因此，我们的目的是评估各种危险因素对超声引导下经皮肝穿刺活检诊断占位性病变的疗效和并发症的影响.
方法：这项回顾性观察性研究包括2012年12月至2018年2月期间在圣地亚哥科利尼科大学医院影像诊断部门接受实时超声引导下经皮肝占位性病变活检的所有患者。我们分析了以下危险因素：上肝段病变的位置（II，IVa,VII,或VIII）；接近肝囊，距离皮肤>100mm，骨或血管结构的插入，无法通过健康的实质，在手术过程中缺乏患者合作。根据获得的圆柱体数量和适当活检的百分比分析疗效；根据并发症的百分比分析安全性，分为主要或次要。
结果：我们纳入了278例患者的295例活检（中位年龄，69岁；64.1%为男性；44.7%曾有肿瘤）。在61.4%中，活检用于初始诊断;82.4％的活检是在住院患者中进行的，65%的病灶位于肝右叶。获得的圆柱体的中位数为3（范围1-6）；91.2％的活检是足够的，92.2％的活检被认为是临床有用的。根据风险因素的存在，这些百分比没有显着差异。10例（3.4%）患者发生并发症。3例（0.9％）患者的并发症被认为是严重的（2例（0.6％）出血并发症和1例（0.3％）感染并发症），7例（2.4％）的并发症较小。在手术过程中不配合的患者的并发症百分比明显更高（P=0.04）。
结论：超声引导下经皮肝穿刺活检是一种有效、安全的肝脏占位性病变组织学诊断技术。我们的结果证实，当患者在手术过程中未能合作时，并发症的发生率会增加。
方法：这项回顾性观察性研究包括2012年12月至2018年2月期间在圣地亚哥科利尼科大学医院影像诊断部门接受实时超声引导下经皮肝占位性病变活检的所有患者。我们分析了以下危险因素：上肝段病变的位置（II，IVa,VII,或VIII）；接近肝囊，距离皮肤>100mm，骨或血管结构的插入，无法通过健康的实质，在手术过程中缺乏患者合作。根据获得的圆柱体数量和适当活检的百分比分析疗效；根据并发症的百分比分析安全性，分为主要或次要。
结果：我们纳入了278例患者的295例活检（中位年龄，69岁；64.1%为男性；44.7%曾有肿瘤）。在61.4%中，活检用于初始诊断;82.4％的活检是在住院患者中进行的，65%的病灶位于肝右叶。获得的圆柱体的中位数为3（范围1-6）；91.2％的活检是足够的，92.2％的活检被认为是临床有用的。根据风险因素的存在，这些百分比没有显着差异。10例（3.4%）患者发生并发症。3例（0.9％）患者的并发症被认为是严重的（2例（0.6％）出血并发症和1例（0.3％）感染并发症），7例（2.4％）的并发症较小。在手术过程中不配合的患者的并发症百分比明显更高（P=0.04）。
结论：超声引导下经皮肝穿刺活检是一种有效、安全的肝脏占位性病变组织学诊断技术。我们的结果证实，当患者在手术过程中未能合作时，并发症的发生率会增加。
