Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle

Liver biopsy continues to play a critical role in the evaluation and management of patients with liver disease. Although history, physical examination, and serological markers often obviate the need for a diagnostic liver biopsy, it is still considered the criterion standard, especially when the etiology of liver disease remains obscure. Even with a thorough history and laboratory workup, significant fibrosis and/or cirrhosis can be missed in as many as 32% of patients without a liver biopsy. 1 In fact, results of a liver biopsy have been shown to alter diagnosis in as many as 14% of patients with chronically elevated liver enzymes and significantly affect patient management in as many as 18% of such patients. 1,2 Moreover, current noninvasive imaging and serological markers of hepatic fibrosis remain investigational and have not been shown to be as accurate as liver biopsy. EUS has an established and integral role in the diagnosis, management, and treatment of several GI, liver, and pancreaticobiliary diseases. New indications and techniques for EUS continue to emerge as experience grows with this technology. Although there are reports of EUSguided FNA of the liver for evaluation of discrete hepatic lesions, there is only limited information on the role of EUS in assisting with diagnostic liver biopsy. Only 1 study to date has evaluated the histological adequacy of liver tissue obtained with EUS guidance; this particular study used the 19-gauge Tru-Cut core biopsy needle. 3 There are no data regarding histological adequacy when EUS-guided liver biopsy is performed by using a 19-gauge FNA needle. It is presumed that use of such a needle may limit the histological adequacy of the specimen obtained. 4 It remains uncertain whether EUS-guided liver biopsy by using a 19-gauge aspiration needle can acquire an adequate tissue specimen to provide a histological diagnosis. Therefore, the primary aim of this study was to evaluate the histological adequacy of liver tissue specimens obtained using a 19-gauge aspiration needle via a EUSguided approach. Specifically, we analyzed the length of the biopsy specimen, the number of complete portal tracts (CPTs), and the ability of the pathologist to make a diagnosis with the obtained specimen.