Comparative Study of an Ultrasound-guided Percutaneous Biopsy and Endoscopic Ultrasound-guided Fine-needle Aspiration for Liver Tumors

Abstract

Objective Both a percutaneous biopsy and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) have been widely performed for liver tumors. However, no studies have compared these two biopsy methods. Method A retrospective study was conducted using medical records for patients who underwent a liver tumor biopsy from 2012 to 2019. The cases were classified into two groups for a comparison: an ultrasound-guided percutaneous biopsy group (percutaneous group) and an EUS-FNA group (EUS group). Results A total of 106 patients (47 in the percutaneous group and 59 in the EUS group) were included. The final diagnosis was malignant in 100 cases and benign in the remaining 6 cases. While the median lesion diameter was 62 mm in the percutaneous group, it was significantly smaller (34 mm) in the EUS group (p <0.01). The EUS group had more left lobe tumors than right lobe tumors. All cases of caudate lobe tumor (four cases) underwent EUS-FNA. The sensitivity, specificity, and accuracy of the procedure were 95%, 100%, and 96% in the percutaneous group and 100%, 100%, and 100% in the EUS group, respectively showing no significant difference. Adverse events were reported in 17% of the percutaneous group, which was significantly lower than in the EUS group (2%; p <0.01). Conclusion A percutaneous biopsy and EUS-FNA have equivalent diagnostic qualities for liver tumors, although EUS-FNA tends to be associated with fewer adverse events. A complete understanding of the characteristics of each procedure is essential when choosing the best biopsy method for each particular case.

Keywords: EUS-FNA; liver tumor; percutaneous biopsy.

Figure 1.

a: Abdominal contrast-enhanced CT showed a large tumor with cystic degeneration in the pancreas tail and small liver metastasis in the caudate lobe (arrow). Since dissemination and infection from a pancreatic tumor biopsy were a concern, we decided to perform a biopsy of the liver metastases. b: Abdominal ultrasonography revealed an obscure tumor in the caudate lobe (arrow). A percutaneous biopsy was difficult for this case. c: The liver tumor in the caudate lobe was easily visualized by EUS (arrowhead), and EUS-FNA was performed with a 22-G needle. d: The pathological diagnosis was adenocarcinoma consistent with pancreatic cancer metastasis, and chemotherapy was initiated. Ad: adenocarcinoma, H: Hepatocyte (Hematoxylin and Eosin staining, ×400)

Figure 2.

a: A case with a history of ovarian cancer, thyroid cancer, and colorectal cancer. Abdominal enhanced computed tomography revealed a 30-mm tumor in segment 6 of the liver. A histological evaluation was required to identify the primary tumor that gave rise to the metastasis. b: The hyperechoic tumor was clearly visualized by abdominal ultrasound. A percutaneous biopsy was performed. c: Adenocarcinoma with spindle-shaped nuclei was detected. The patient was diagnosed with liver metastasis of colorectal cancer. Ad: adenocarcinoma, H: Hepatocyte (Hematoxylin and Eosin staining, ×400)

Figure 3.

a: Abdominal enhanced CT showed an irregular tumor of 30 mm in segment 8 of the liver. An ascending and transverse colon was located in front of the liver (Chilaiditi syndrome). A histological examination was required for chemotherapy because the patient refused surgery. b: It was difficult to visualize the tumor due to gastrointestinal gas (arrowhead) on abdominal ultrasound. c: EUS was able to visualize the tumor (arrow) without being affected by gastrointestinal gas. EUS-FNA was performed from the duodenal bulb. d: The patient was diagnosed with intrahepatic cholangiocellular carcinoma. Ad: adenocarcinoma, H: Hepatocyte (Hematoxylin and Eosin staining, ×400)

Figure 4.

a: Abdominal ultrasonography showing numerous hypoechoic masses in the liver. A full-body evaluation failed to reveal any clear primary lesion, and a percutaneous liver biopsy was performed prior to chemotherapy. The patient was diagnosed with intrahepatic cholangiocellular carcinoma. No antithrombotic drug was taken in this case, and the platelet count and coagulation ability were normal. b: The day after the biopsy, the patient complained of abdominal pain and exhibited a decreased blood pressure and tachycardia. A decrease in blood hemoglobin was observed (from 9.5 to 6.8 g/dL), and blood transfusion was performed. Contrast-enhanced computed tomography showed extravasation on the surface of the liver (arrowhead). c: Angiography showed extravasation from the periphery of the right hepatic artery (arrow), and transcatheter arterial embolization was performed.