title: Optimizing needle direction during transjugular liver biopsy provides superior biopsy specimens.
abstract: OBJECTIVE
  Transjugular liver biopsy (TJLB) is commonly performed for staging of liver fibrosis and cirrhosis among patients with coagulopathy and/or ascites. We hypothesized that device orientation during needle firing influences hepatic tissue apposition with the specimen notch and specimen quality.
  
  
  METHODS
  Needle biopsies were performed in ex vivo bovine livers with specimen notch of the biopsy device oriented at cranial, caudal, or lateral directions with respect to the guiding metal cannula. Biopsy specimen length was measured and evaluated for fragmentation using light microscopy. In addition, a consecutive cohort of patients (n = 50) who underwent TJLB with random (n = 22) or caudal (n = 28) needle orientation was retrospectively reviewed. The number of needle passes was documented, and pathology specimen adequacy was graded using an ordinal scale.
  
  
  RESULTS
  A total of 400 biopsies were performed (100 in each orientation) in ex vivo bovine livers. Longer specimens were obtained with caudal orientation of the needle specimen notch (p < 0.0001, ANOVA and Kruskal-Wallis tests). There was no difference in the degree of fragmentation. In the retrospective clinical study, specimen adequacy was significantly higher among patients in the caudal orientation group (p = 0.0002, Mann-Whitney U test).
  
  
  CONCLUSIONS
  Caudal orientation of the needle specimen notch of the biopsy device during TJLB produces superior core biopsy specimens. This simple technical modification may assist in obtaining higher-quality biopsy specimens during TJLB.
authors.affiliation: Section of Interventional Radiology, Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, 39th and Market Streets, Philadelphia, PA, 19104, USA, timothy.clark@uphs.upenn.edu.
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: McCann
authors.forename: Jason
authors.initials: J
authors.lastname: Salsamendi
authors.forename: Michael F
authors.initials: MF
authors.lastname: Dowd
authors.forename: Cristina H
authors.initials: CH
authors.lastname: Hajdu
mesh_terms: D000818:Animals; D001201:Ascites / Q000473:pathology; D001707:Biopsy, Needle / Q000379:methods*; D001778:Blood Coagulation Disorders / Q000473:pathology; D002417:Cattle; D006801:Humans; D066298:In Vitro Techniques; D008103:Liver Cirrhosis / Q000473:pathology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional