title: Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part I. Procedural aspects, diagnostic adequacy, and accuracy.
abstract: OBJECTIVE
  To assess procedural aspects, diagnostic adequacy, and accuracy of liver biopsy across the United Kingdom.
  
  
  METHODS
  Institutional review board approval for this type of study is not required in the United Kingdom. All radiology departments with an approved leader for departmental audit registered with the Royal College of Radiologists were invited to participate in this retrospective audit. The first 50 consecutive patients who underwent image-guided or image-assisted liver biopsy in 2008 were included. Audit standards relating to procedural aspects of biopsy, sample adequacy, and accuracy were prepared with reference to published data. Sensitivity, specificity, positive and negative likelihood ratios, and accuracy were calculated. Organizational and clinical variables were investigated for their association with diagnostic specimen quality.
  
  
  RESULTS
  Eighty-seven (41%) of 210 departments supplied data for this study, with a total of 3496 cases (1225 focal disease, 2262 nonfocal disease, nine unspecified). Ultrasonographic (US) guidance was the technique most commonly used for focal lesions and for cases of nonfocal disease (2808 [96.38%] of 3490 cases). The audit standard for sample adequacy (98%) was narrowly missed in practice (3401 [97.96%] of 3472 cases); however, the standard for diagnostic accuracy (90%) was met (3187 [98.55%] of 3234 cases). Poor compliance with postbiopsy documentation was observed.
  
  
  CONCLUSIONS
  The majority of liver biopsies in this audit were performed by radiologists using image guidance or assistance, usually in the form of US. Biopsies were performed with a high degree of accuracy. Some postprocedural aspects of biopsy failed to meet required standards and would merit reaudit after practice changes.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111562/-/DC1.
authors.affiliation: Department of Radiology, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, England BN21 2UD. david.howlett@esht.nhs.uk
authors.forename: David C
authors.initials: DC
authors.lastname: Howlett
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Drinkwater
authors.forename: David
authors.initials: D
authors.lastname: Lawrence
authors.forename: Susan
authors.initials: S
authors.lastname: Barter
authors.forename: Tony
authors.initials: T
authors.lastname: Nicholson
mesh_terms: D001706:Biopsy / Q000379:methods*; D016009:Chi-Square Distribution; D006801:Humans; D008107:Liver Diseases / Q000473:pathology*; D016015:Logistic Models; D008485:Medical Audit / Q000592:standards*; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*; D006113:United Kingdom