Ultrasound-guided liver biopsy of focal lesions: comparison between direct and coaxial techniques

Abstract

Introduction: Ultrasound-guided liver biopsy is an essential tool for the histological diagnosis of focal hepatic lesions. Both direct and coaxial puncture techniques are widely used in clinical practice, although comparative evidence regarding diagnostic performance and safety remains limited.

Material and methods: We conducted a retrospective, single-center study including 295 consecutive ultrasound-guided liver biopsies of focal lesions performed between December 2012 and February 2018. The primary objective was to compare diagnostic adequacy between coaxial and direct techniques. Secondary objectives were to assess sample adequacy (number of cores obtained) and complication rates. Diagnostic adequacy was classified as satisfactory, insufficient, or failed biopsy. Complications were classified according to Society of Interventional Radiology (SIR) criteria.

Results: A total of 278 patients (64.1% male; median age, 69 years) were included. The coaxial technique was associated with higher diagnostic adequacy (92.8% vs. 89.4%; p = 0.014) and greater sample adequacy (mean cores: 3.6 vs. 2.7; p <0.001), with no significant differences in complication rates (2.6% vs. 4.2%; p = 0.683). In multivariate analysis, the coaxial technique remained an independent predictor of diagnostic adequacy (OR 2.45; 95% CI: 1.12-5.37; p = 0.024).

Conclusions: Ultrasound-guided percutaneous liver biopsy is a safe and effective technique for the evaluation of focal hepatic lesions. The coaxial technique improves diagnostic adequacy and sample yield without increasing complication rates, supporting its preferential use in clinical practice.