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. 2025 Jun;28(2):537-540.
doi: 10.1007/s40477-024-00949-x. Epub 2024 Nov 2.

Ultrasound-guided percutaneous biopsy for challenging perihilar focal liver lesions: diagnostic accuracy and safety assessment

Roberto Ceriani  1   2 , Francesca Colapietro  3   4 , Roberto Gabbiadini  4 , Arianna Dal Buono  3   4 , Nicola Pugliese  3   4 , Chiara Masetti  4 , Luca Brandaleone  3   4 , Tiziana Ierace  5 , Luigi Solbiati  3   5
Affiliations

Ultrasound-guided percutaneous biopsy for challenging perihilar focal liver lesions: diagnostic accuracy and safety assessment

Roberto Ceriani et al. J Ultrasound. 2025 Jun.

Abstract

Purpose: In cases of perihilar focal liver lesions, distinguishing between benign strictures and malignancies is critical to prevent unnecessary surgery. Although the use of contrast-enhanced CT or MRI in combination with clinical and laboratory findings can aid in diagnosis, histologic examination is often necessary. Histologic specimens can be obtained through various techniques, including ERCP-guided brush cytology or intraductal biopsy, cholangioscopy-directed biopsy or endoscopic ultrasound (EUS). However, these methods have been associated with suboptimal sensitivity and specificity, sometimes leading to inconclusive results. Therefore, ultrasound-guided percutaneous biopsy (US-guided PB) may play a crucial role, but data is lacking for perihilar lesions. The objective of our study was to assess the technical feasibility and safety of US-guided PB for perihilar lesions.

Methods: We included 20 consecutive patients who underwent US-guided PB of perihilar liver lesions that were not suitable for surgery between June 2018 and October 2023.

Results: All samples were obtained using a Menghini needle 20G and were adequate for histological examination, with a mean diameter of 12.3 mm (range 3-40 mm). Out of the 20 patients, 11 were diagnosed with malignancy while the remaining 9 had inflammatory or fibrotic tissue samples. No adverse events related to the procedure were reported.

Conclusion: US-guided PB of perihilar liver lesions is a valuable and safe diagnostic approach to consider for patients who are not suitable for surgery.

Keywords: Cholangiocarcinoma; Liver biopsy; Malignancy; Neoplasia; Perihilar lesion.

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Conflict of interest statement

Declarations. Conflict of interest: All the authors have given substantial contribution to the completion of this work and have seen and approved the text in the current version. None reported a conflict of interest with respect to this manuscript.

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