Comparison of Blind and Ultrasound Guided Liver Biopsy Where There is No Functional Interventional Radiology Unit: Our Experience in a Tertiary Health Facility in North-Eastern Nigeria

Authors: Aliyu S and Ningi AB*

Volume 5, Issue 1

Abstract

Background: A fundamental limitation encountered in the management of Hepatic disease is obtaining specimen for histopathological diagnosis. Traditionally, bedside percutaneous biopsy, either blind or image guided; has been used with some measure of success. The various complications that follow such procedure, particularly, reactionary haemorrhage, biliary leak and peritonitis, septicaemic shock and eventual death have made the procedure hazardous. Most procedure related complications and death are said to occur within 6 hours after the procedure. Although, many single centre, small sample size studies reported a decreased complication and mortality rates with image guided biopsy, no large volume Randomised controlled trial has shown that. Objective: we aim to compare the diagnostic yield, morbidity and mortality rates between blind and image USS guided liver biopsy Materials and Methods: This is a prospective study of blind and image guided bedside Liver biopsies for patients with palpably enlarged or nodular liver at the Hepatobiliary Unit of the department of Surgery, University of Maiduguri Teaching Hospital, Borno state, Nigeria. All biopsies were taken with Menghini’s Needle after assessing the clinical, haematological and biochemical fitness of all the patients for the procedure. The study included 46 patients that were seen between 1st November 20004- 30th November 2013. Informed consent was obtained from all patients and Ethical clearance was granted by the hospital management. All data were analysed with SPSS 20.0 software for correlation of outcomes. Results: A total of 46 patients were recruited, with 31 males and 15 females, giving a male to female ratio of 2:1. The mean age was 40.5(±3.4). 65.2% had blind biopsy and 34.8% had USS guided biopsy. There were 6.5% failed biopsies in the blind group, indicating 93.5% sensitivity and none in USS guided group, showing 100% sensitivity. The most common histopathological diagnosis obtained was Hepatocellular carcinoma (26.1%) and the least common were hepatoblastoma, chronic persistent hepatitis and benign liver cyst, 2.2% each. All the patients with hepatocellular carcinoma are in their 4th decade of life and Liver cirrhosis has been found to co-exist with hepatocellular carcinoma in about 5% of the patients. All metastatic adenocarcinomas are seen in patients within their 5th and 6th decades of life. The second most common diagnosis is chronic active hepatitis (17.1%). 87.5% of all those with chronic active hepatitis are males and majority are in their 2nd and 3rd decades of life. 82.6% suffered no complications. The most common complication is reactionary haemorrhage (8.7%). 87.5% of the complications are in the blind liver biopsy group and 12.5% in the USS guided group. 4.3% suffered a life threatening haemorrhagic shock. Conclusion: although majority of the complications are seen in the blind liver biopsy group, the difference is not statistically significant ( X2 = 2.67, P = 0.445)

Keywords: Liver Biopsy; Blind; USS Guided

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