title: Improved tissue sections for medical liver biopsies: a comparison of 16 vs 18 g biopsy needles using digital pathology.
abstract: BACKGROUND
  Most medical liver biopsies in the UK are now taken in radiology departments using 18 g biopsy needles. Subjectively, the resulting biopsies are narrow and fragile.
  
  
  OBJECTIVE
  To compare the quality of liver biopsy tissue sections obtained from 16 and 18 g biopsy needles.
  
  
  METHODS
  Fifty consecutive routine medical liver biopsies obtained with 16 and 18 g needles, processed identically in the same laboratory, were measured using digital pathology software. We recorded their fragmentation, length, width, area and number of portal tracts.
  
  
  RESULTS
  Biopsies obtained with 16 g needles more often resulted in an intact core in tissue sections than those with 18 g needles (71% vs 24%, p<0.001) and were significantly wider (average width of tissue 0.88 vs 0.53 mm, p<0.001). The average total area of tissue per pass was 11.38 mm(2) compared with 8.34 mm(2) (p<0.001). The number of complete portal tracts per length of biopsy was very variable, but double for 16 vs 18 g biopsies. Routinely taking two passes with the 18 g needle compensated for the reduced area, but the resulting liver in tissue sections was fragmented and distorted.
  
  
  CONCLUSIONS
  Our results support the routine use of 16 g rather than 18 g biopsy needles for routine ultrasound-guided medical liver biopsies. A second pass should be considered if the first biopsy core is short, especially for investigation of disease stage.
authors.affiliation: Department of Histopathology, St James's Hospital, , Leeds, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Palmer
authors.forename: Izabela
authors.initials: I
authors.lastname: Georgiades
authors.forename: Darren
authors.initials: D
authors.lastname: Treanor
authors.forename: Alexander
authors.initials: A
authors.lastname: Wright
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Shah
authors.forename: Randeep
authors.initials: R
authors.lastname: Khosla
authors.forename: Judith I
authors.initials: JI
authors.lastname: Wyatt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000295:instrumentation* / Q000379:methods; D004739:England; D004867:Equipment Design; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy / Q000295:instrumentation* / Q000379:methods; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011237:Predictive Value of Tests; D012984:Software; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: DIAGNOSIS; DIGITAL PATHOLOGY; LIVER