03:00 PM Abstract No. 373 Prospective comparison of liver biopsy devices: biopsy specimen adequacy for full thickness versus sidecut

The purpose of these studies was to determine which percutaneous device yielded the best samples for staging of liver disease based on the standard criteria for adequate biopsy. Liver core biopsy specimens obtained using two different techniques were compared: site-marked/single pass 16G sidecut (SM16) (Monopty, CR Bard, Tempe AZ), and ultrasound-guided/single 18G full thickness (US18) (Biopince, Argon Medical, Frisco, TX). All US18 biopsies were performed by board certified interventional radiologists, while all SM16 biopsies were performed by board certified hepatologists. Specimens were prospectively assessed by one of two board certified pathologists who specialize in liver pathology. All samples were evaluated for total CPT count and subjective fragmentation, as well as sample adequacy which was defined as CPT count >11. A logistic regression model was fit, where the dichotomous variable of sample adequacy (as determined by the sample containing at least 11 CPTs) was used as the outcome measure and device type (using the US18 device as the reference category) as the only predictor variable. Significance of the device type parameter estimate was determined at the α=0.05 level. 40 US18 and 56 SM16 biopsies were consecutively performed and analyzed. Mean number of passes was 1.0 for US18 and 1.1 for the SM16, and (P>0.7). Mean number of CPT per specimen was 25.4 for US18 and 11.8 for SM16 (p<0.0001). 97.5% of US18 and 64% of SM16 were deemed adequate (p<0.003). There was no significant difference in respective complication rates or subjective fragmentation assessment (p>0.5). US18 was superior to SM16 both in terms of number of CPTs per sample as well as the likelihood of a diagnostically adequate sample for staging fibrosis. This is despite a smaller gauge and with the same number of passes. The rate of complications and fragmentation was similar. Adoption of the 18G full thickness device into non–image-guided/single-pass (SM16) biopsy practices will likely yield more CPT and higher specimen adequacy without an increase in the number of passes required, as well as a smaller gauge device.