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The benefit of contrast-enhanced ultrasound in biopsies for focal liver lesions: a retrospective study of 820 cases

  • Interventional
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European Radiology Aims and scope Submit manuscript

Abstract

Objective

This study compared the performance between ultrasound (US)- and contrast-enhanced US (CEUS)–guided liver biopsies and evaluated the benefit of CEUS in percutaneous biopsy for focal liver lesions (FLLs).

Methods

We performed a retrospective study of 820 patients with FLLs, who underwent percutaneous liver biopsy in our center between 2017 and 2019. The patients were divided into two groups based on whether US (n = 362) or CEUS (n = 458) used before a biopsy. The two groups were compared based on specimen adequacy for pathological diagnosis and diagnostic accuracy of liver biopsy. Stratification analysis was performed based on lesion and protocol characteristics to provide detailed information for selecting the imaging guidance for biopsy.

Results

Compared with the US group, the CEUS group yielded more acceptable samples (97.6% vs. 99.4%, p < 0.05) and improved diagnostic accuracy (92.6% vs. 96.4%, p < 0.05), and achieved better sensitivity (92.5% vs. 96.2%, p < 0.05) for liver biopsies, especially in FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. The CEUS group showed significantly higher accuracy compared with the US group pertaining to single-puncture biopsies (100% vs. 92.7%, p < 0.05) or biopsies with punctures ≤ 2 (97.6% vs. 94.3%, p < 0.05).

Conclusion

CEUS achieved an enhanced success rate for sampling and diagnostic accuracy of liver biopsies, especially in FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. CEUS can be used to decrease the number of punctures needed, which might increase the safety of liver biopsy.

Key Points

• CEUS can help confirm an adequate biopsy site, increasing the sampling success rate and diagnostic accuracy of the liver biopsy.

• CEUS can be used to decrease the number of punctures needed to improve the safety of liver biopsy.

• It is recommended to use CEUS guidance for liver biopsies, especially with FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary.

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Abbreviations

AFSUMB:

Asian Federation of Societies for Ultrasound in Medicine and Biology

CDFI:

Color Doppler flow imaging

CEUS:

Contrast-enhanced ultrasound

CT:

Computed tomography

EFSUMB:

European Federation of Societies for Ultrasound in Medicine and Biology

FLLs:

Focal liver lesions

FNH:

Focal nodular hyperplasia

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

M:

Male

MI:

Mechanical index

MRI:

Magnetic resonance imaging

SD:

Standard deviation

US:

Ultrasonography

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Acknowledgements

The authors would like to express their gratitude to EditSprings (https://www.editsprings.com/en?type = com/) for the expert linguistic services provided. We also thank all of the patients involved in the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Jia-Xin Huang and Cai-Gou Shi contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China

    Jia-Xin Huang, Yan-Fen Xu, Juan Fu, Long-Zhong Liu & Xiao-Qing Pei

  2. Department of Medical Ultrasound, Liuzhou People’s Hospital, Liuzhou, 545000, China

    Cai-Gou Shi

  3. Department of Medical Ultrasound, Foshan First People’s Hospital, Foshan, 528000, China

    Yuan Zhong

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  1. Jia-Xin Huang
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  4. Juan Fu
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Correspondence to Xiao-Qing Pei.

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The scientific guarantor of this publication is Xiao-Qing Pei.

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The authors declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical method was necessary for this paper.

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Written informed consent was waived by the Institutional Review Board for this retrospective study.

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Institutional Review Board approval was obtained.

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• performed at one institution

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Huang, JX., Shi, CG., Xu, YF. et al. The benefit of contrast-enhanced ultrasound in biopsies for focal liver lesions: a retrospective study of 820 cases. Eur Radiol 32, 6830–6839 (2022). https://doi.org/10.1007/s00330-022-08988-w

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  • DOI: https://doi.org/10.1007/s00330-022-08988-w

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