title: Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs.
abstract: OBJECTIVE
  Our objectives were: (1) to assess the clinical benefits and costs of performing ultrasound-guided liver biopsy with an automated needle compared to blind biopsy with a conventional Trucut needle in patients with chronic hepatitis C; (2) to compare the histological yield of automated needles with Trucut needles.
  
  
  METHODS
  We prospectively studied 166 patients with hepatitis C virus who underwent either ultrasound-guided biopsy using automated ASAP needles or blind biopsy using conventional Trucut needles. Both groups were matched for age, sex, cirrhosis, needle gauge and operator experience. Patient tolerance, complications and histological adequacy were assessed. In a separate in vitro study, we assessed the histological adequacy of liver biopsy specimens obtained using automated and Trucut needles from 10 fresh autopsy cases.
  
  
  RESULTS
  Ultrasound-guided biopsy caused significantly less biopsy pain (36.4% vs. 47.3%; p < 0.0001) and significantly less pain-related morbidity (1.8% vs. 7.7%, p < 0.05). Although, there was no significant difference in diagnostic yield between guided and blind biopsy (98% vs. 94%, p = 0.15), 3 blind biopsies (3.3%), including 2 which yielded extra-hepatic tissue, had to be repeated. The additional expense of performing guided liver biopsy with automated needles was 42 Irish Pounds per patient. In vitro, automated ASAP 15G needles provided liver specimens comparable to Trucut 15G needles and had the highest histopathologic score among the automated needles assessed.
  
  
  CONCLUSIONS
  Even in the absence of major complications, ultrasound-guided liver biopsy with an automated needle in HCV patients is safer, more comfortable and only marginally more expensive than blind Trucut biopsy.
authors: Department of Hepatology, St James's Hospital, Trinity College Dublin, Ireland. rfarrell@bidmc.harvard.edu
authors: R J
authors: RJ
authors: Farrell
authors: P F
authors: PF
authors: Smiddy
authors: R M
authors: RM
authors: Pilkington
authors: A A
authors: AA
authors: Tobin
authors: E E
authors: EE
authors: Mooney
authors: I J
authors: IJ
authors: Temperley
authors: G S
authors: GS
authors: McDonald
authors: H A
authors: HA
authors: Bowmer
authors: G F
authors: GF
authors: Wilson
authors: D
authors: D
authors: Kelleher
mesh_terms: D000328:Adult; D001331:Automation; D001344:Autopsy; D001707:Biopsy, Needle / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D004867:Equipment Design; D005260:Female; D006467:Hemophilia A / Q000150:complications; D019698:Hepatitis C, Chronic / Q000191:economics / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007494:Ireland; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology*; D008297:Male; D009017:Morbidity; D009339:Needles; D010146:Pain; D014463:Ultrasonography; D014842:von Willebrand Diseases / Q000150:complications