Coarse vs. fine needle aspiration biopsy for the assessment of diffuse liver disease from hepatitis C virus-related chronic hepatitis.
OBJECTIVE
Liver biopsy is crucial in defining natural history and therapeutic choices in chronic hepatitis C and it is usually performed with coarse (>1 mm) needles (CN). As fine needles (FN) do not require anaesthesia, are used over a wider range of coagulation values and allow multiple passes, we compared the diagnostic yield of FN vs. CN biopsies.


METHODS
Paired samples obtained with FN (0.8 mm) and CN (1.2 mm) on 149 consecutive outpatients from a tertiary care institution were evaluated prospectively. Histologic variables were quantitatively scored. Sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were calculated as measures of diagnostic ability assuming CN as reference.


RESULTS
FN biopsy was adequate in 83 cases, CN in 140 cases (P<0.001). Considering the 83 paired adequate specimens, the best sensitivity of FN vs. CN was for portal inflammation (0.95%) and the worst for cirrhosis (0.33%). Overall discriminant ability of FN was unsatisfactory and histologic variables were systematically underscored. Tolerability was good for both procedures.


CONCLUSIONS
The advantages of FN biopsy are lost on its inferior diagnostic performance. Its use in diffuse liver diseases should be restricted to early non-fibrotic lesions.
Brunetti
Enrico
E
Division of Infectious and Tropical Diseases, IRCSS S. Matteo, University of Pavia, Via Taramelli 5, 27100 Pavia, Italy. selim@unipv.it
Silini
Enrico
E
Pistorio
Angela
A
Cavallero
Alessandra
A
Marangio
Anna
A
Bruno
Raffaele
R
Filice
Carlo
C
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000592:standards*; D001707:Biopsy, Needle / Q000592:standards*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D016013:Likelihood Functions; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity