Most are performed by radiologistsBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6981.739 (Published 18 March 1995) Cite this as: BMJ 1995;310:739
- R J Davies,
- C S Ward
EDITOR,—Guy Vautier and colleagues' editorial finishes with the totally unsubstantiated assertion that the “ideal liver biopsy is one that is performed on the ward by the gastroenterologist using ultrasound guidance.”1 In Britain most biopsies of the liver (and other organs) for focal disease are successfully performed by radiologists in the radiology department. The radiologist selects the most appropriate imaging technique for the patient and lesion, usually either ultrasonography or computed tomography. Radiologists have the advantage of familiarity with the imaging equipment and the cross sectional display of anatomy. The patient is accompanied by a nurse, who escorts him or her back to the ward; therefore patients are not left “without being observed during the time when at least 60% of complications occur.” The editorial does not state who performed the liver biopsies in the studies quoted or the type of biopsy needle used. We routinely use a Biopty gun (or equivalent), a spring loaded automated device that produces clean, relatively atraumatic tissue samples. We consider it to be a definite advance on the technique that uses a Menghini needle. Further radiological refinements involve the application of angiographic skills either to embolise the track of the percutaneous liver biopsy needle or to obtain a transjugular liver biopsy specimen to minimise the risk of haemorrhage in those in whom biopsy is imperative but coagulation appreciably impaired.
Although the liver is large, its position varies considerably among patients and can alter by 5 cm or more with deep respiration. If the liver is not localised ultrasonographically before biopsy it may be missed completely; this is in addition to the problem of inadvertent puncture of gall bladder or portal vein. Therefore imaging guidance is of value in diffuse as well as focal disease.