title: Success of image-guided biopsy for small (≤ 3 cm) focal liver lesions in cirrhotic and noncirrhotic individuals.
abstract: OBJECTIVE
  Imaging techniques can detect small liver lesions, although these are a challenge to biopsy, particularly in cirrhotic liver. The authors assessed the diagnostic success of image-guided biopsies collected from small (≤ 3 cm) focal liver lesions.
  
  
  METHODS
  This single-center, retrospective study included 374 patients (199 men; mean age, 62 ± 15). Eighteen-gauge core biopsy and 22-gauge fine needle aspiration (FNA) samples were collected from small focal liver lesions. Samples were compared by histology versus cytology, malignant versus benign, from lesions smaller versus larger than 1.5 cm, from livers with versus without cirrhosis, collected by computed tomography (CT) guidance versus ultrasound, and from different locations in the liver.
  
  
  RESULTS
  The combined accuracy of core biopsy plus FNA analysis was 95.5%; core biopsy alone characterized 93.3% of samples, and FNA alone characterized 72.5% (P < .001). Biopsy successfully characterized 94.5% of malignant lesions and 98.8% of benign lesions (P > .05). Biopsy characterized 95.3% (102 of 107) lesions ≤ 1.5 cm. The success in cirrhotic livers was 94.8%, for CT-guided biopsies was 95%, and for ultrasound-guided biopsies was 95.8% (P > .05). The success rate was lower in liver caudate lobe than in other locations (P < .05).
  
  
  CONCLUSIONS
  Image-guided biopsy of small (≤ 3 cm) focal liver lesions is highly reliable with the use of core biopsy alone. Neither size ≤ 1.5 cm nor presence of cirrhosis is an impediment to biopsy. CT and ultrasound guidance produce similar rates of success.
authors.affiliation: Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
authors.forename: Xiaozhou
authors.initials: X
authors.lastname: Ma
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Arellano
authors.forename: Debra A
authors.initials: DA
authors.lastname: Gervais
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hahn
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
authors.forename: Dushyant V
authors.initials: DV
authors.lastname: Sahani
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*