Liver Biopsy: What Method?

Biopsy specimens are necessary for making definitive diagnoses in many cases of liver disease. The most commonly used sampling techniques are large-gauge biopsy needles, biopsy punches, biopsy forceps and scissors, or scalpel blades. Hemorrhage is a serious complication. In this study, biopsy specimens were obtained from the periphery and center of the lateral liver lobe of 12 healthy dogs using 5 different biopsy techniques: biopsy punch, biopsy needle, ligature method, laparoscopic biopsy forceps, and ultrasonically activated scalpel (UAS). The amount of hemorrhage was quantified by comparing the weight of filter paper before and after soaking up the blood resulting from the procedure. Damage to biopsy specimens and quality of specimens were also assessed. All of the biopsy techniques resulted in minimal hemorrhage. The biopsy punch caused the most bleeding. The UAS provided the best hemorrhage control for central biopsies. For peripheral biopsies, the UAS and ligature methods were similar. Except for needle biopsy, all provided an adequate amount of tissue for histologic examination-8 of 48 needle biopsy specimens were inadequate for histologic diagnosis. UAS and ligature biopsy techniques yielded tissue specimens with more portal triads per sample than the other techniques. The UAS caused the most collateral damage to other tissues. Considering the amount of collateral tissue damage, if a UAS is used a specimen block of 1 × 1 × 1 cm should be obtained. For the other techniques, crushing was the most common problem and was a direct result of tissue handling.

COMMENTARY: It is important to remember that the dogs in this study were healthy. Sick animals may bleed more. Coagulation studies should be done before liver biopsy is pursued. UAS may be the preferred technique in fragile patients with marginal coagulation status. UAS and ligature biopsy techniques yielded superior specimens with respect to sample size and number of portal triads per sample.

Evaluation of hemorrhage, sample size, and collateral damage for five hepatic biopsy methods in dogs. Vasanjee SC, Bubenik LJ, Hosgood G, et al. VET SURG 35:86-93, 2006.