Diagnostic interventional procedures of small liver lesions under ultrasound control

Purpose: The present study assess factors affecting the success of US -guided liver biopsy of small focal lesions on the basis of experience when cytopathologic examination results were available.

Material and methods: 135 fine-needle liver biopsies and punctures in 135 patients (80 male and 55 female) were performed under US control. Lesions ranged in diameter from 9 mm to 20 mm. We utilized US guidance in 123 (91.11%) cases and CT guidance in 12 (8.88%) cases. Ultrasound equipment supplied with 3.5 and 7 MHz linear and convex transducers and biopsy needles were used. The on-site cytologic evaluation guided the radiologist to continue to another biopsy pass and avoid a nondiagnostic biopsy result.

Results: During a 5-year period we performed fine needle liver biopsies or punctures in 135 patients (80 males and 55 females) with small (9 – 20 mm) liver lesions. The CT guidance was utilized only for biopsy of non visible deep liver masses and subdiaphragmatically located lesions. Interventional procedures under imaging control of small focal liver lesions had a sensitivity of 97.76%, specificity of 80.48% and accuracy of 93.71%. The PPV is 94.24% and the NPV-91.66%.

Conclusion: Interventional procedures under US control of the small focal liver lesions is a highly reliable, safe, inexpensive invasive procedure with great diagnostic value in suspected HCC less than 2 cm in diameter, liver metastases, as well as all benign tumors without typical findings on either dynamic multi-detector CT or CEUS.