Clin Endosc.  2019 Jul;52(4):340-346. 10.5946/ce.2018.175.

Endoscopic Ultrasound-Guided Liver Biopsy Using a Core Needle for Hepatic Solid Mass

• Chon HK
• Yang HC
• Choi KH
• Kim TH

• KMID: 2455630
• DOI: http://doi.org/10.5946/ce.2018.175

Abstract

BACKGROUND/AIMS
This study aimed to evaluate the feasibility and efficacy of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a core needle for hepatic solid masses (HSMs). Additionally, the study aimed to assess factors that influence the diagnostic accuracy of EUS-FNB for HSMs.
METHODS
A retrospective analysis of patients who underwent EUS-FNB for the pathological diagnosis of HSMs was conducted between January 2013 and July 2017. The procedure had been performed using core needles of different calibers. The assessed variables were mass size, puncture route, needle type, and the number of needle passes.
RESULTS
Fifty-eight patients underwent EUS-FNB for the pathologic evaluation of HSMs with a mean mass size of 21.4±9.2 mm. EUS-FNB was performed with either a 20-G (n=14), 22-G (n=29) or a 25-G core needle (n=15). The diagnostic accuracy for this procedure was 89.7%, but both specimen adequacy for histology and available immunohistochemistry stain were 91.4%. The sensitivity and specificity of EUS-FNB were 89.7% and 100%, respectively. There was one case involving bleeding as a complication, which was controlled with endoscopic hemostasis. According to the multivariate analysis, no variable was independently associated with a correct final diagnosis.
CONCLUSIONS
EUS-FNB with core biopsy needle is a safe and highly accurate diagnostic option for assessing HSMs. There were no variable factors associated with diagnostic accuracy.

Keyword

Endoscopic ultrasound; Fine needle biopsy; Core needle; Hepatic solid mass

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Diagnosis
Hemorrhage
Hemostasis, Endoscopic
Humans
Immunohistochemistry
Liver*
Multivariate Analysis
Needles*
Punctures
Retrospective Studies
Sensitivity and Specificity

Figure

• 

  Fig. 1. (A) Endoscopic ultrasonography imaging showing a 1.1 cm sized, encapsulated, homogenous isoechoic mass in the left lobe of the liver (white arrow). (B) The core needle is visible in the center of the mass (open arrow). (C) The endoscopic ultrasound-guided fine needle biopsy specimen shows tumor nests (arrows) and adjacent normal hepatocytes (arrowhead) (hematoxylin and eosin [H&E], ×100). (D) The small-cell carcinoma shows nuclear molding (arrow) and crushing artifact (arrowhead) (H&E, ×400), these tumor cells are immunoreactive for neuroendocrine markers, likely CD56 (E) (CD56, ×200) and synaptophysin (F) (Synaptophysin, ×200).

• 

  Fig. 2. (A) Magnetic resonance imaging showing a large heterogeneously increasing mass on the right lobe of the liver, which was difficult to differentiate between hepatocellular carcinoma and cholangiocarcinoma (white arrow). (B) A hypoechoic mass with core needle on endoscopic ultrasound. (C) Polygonal hepatocytes with a higher than normal N/C ratio show a trabecular growth pattern with intervening sinusoids (hematoxylin and eosin, ×200). (D) These cells were immunoreactive for hepatocyte specific antigen (Hepatocyte specific antigen, ×200).

• 

  Fig. 3. (A) An abdominal computed tomography scan showing an ill-defined hypoechoic mass (black arrow), on the caudate lobe of liver, which was difficult to access through percutaneous liver biopsy. (B) Endoscopic ultrasound-guided fine needle biopsy with 22 G needle was performed and the mass was diagnosed as metastatic adenocarcinoma.

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