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(Radiology. 2001;218:195-199.)
© RSNA, 2001

Vascular and Interventional Radiology

US-guided Percutaneous Biopsy of Small (<=1-cm) Hepatic Lesions1

Simon C. H. Yu, FRCR, Choong T. Liew, MD, Wan Y. Lau, MD, Thomas W. Leung, MD and Constantine Metreweli, FRCP, FRCR

1 From the Departments of Diagnostic Radiology and Organ Imaging (S.C.H.Y., C.M.), Anatomical and Cellular Pathology (C.T.L.), Surgery (W.Y.L.), and Clinical Oncology (T.W.L.), Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong. From the 1999 RSNA scientific assembly. Received December 6, 1999; revision requested January 13, 2000; revision received March 20; accepted April 3. Address correspondence to S.C.H.Y. (e-mail: chymyl@netvigator.com).

PURPOSE: To determine the accuracy of ultrasonography (US)-guided percutaneous biopsy in diagnosing malignant neoplasms for hepatic lesions 1 cm or smaller.

MATERIALS AND METHODS: In this prospective study, 64 consecutive patients with 74 discrete focal hepatic lesions depicted at US were referred for liver biopsy to confirm the exact nature of the lesions. Mean lesion size was 0.84 cm ± 0.13 (range, 0.5–1.0 cm). Biopsy was performed with an 18-gauge automated biopsy gun in 46 lesions (once [n = 37], twice [n = 7], three times [n = 2]) or a 22-gauge needle in 28 lesions (once [n = 23], twice [n = 4], three times [n = 1]). Measures were taken to ensure accurate and effective lesion sampling. The histologic diagnosis of malignant tumor and findings on follow-up US images of "benign" nodules for 15–39 months were the criterion standard.

RESULTS: No complications occurred. All specimens obtained were sufficient for diagnosis. Histologic examination revealed various types of primary and secondary malignant tumors (n = 44), hemangioma (n = 5), cirrhosis (n = 13), focal fatty change (n = 8), focal fatty sparing (n = 2), and abscess (n = 2). The diagnostic discrimination of US-guided biopsy in diagnosing malignant tumors in these small lesions was sensitivity, 98%; specificity, 100%; positive predictive value, 100%; negative predictive value, 97%; and accuracy, 99%.

CONCLUSION: Percutaneous biopsy under US control is highly accurate in providing a definitive histologic diagnosis of malignant neoplasms for small hepatic lesions if measures for ensuring precise and effective lesion sampling are taken.

Index terms: Biopsies, technology, 76.1261, 76.12985 • Liver, biopsy, 76.1261, 76.12985 • Liver, diseases, 761.21, 761.79 • Liver, nodules, 76.31, 76.32 • Liver neoplasms, diagnosis, 76.1261, 76.12985, 76.30 • Ultrasound (US), guidance, 76.12985




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