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Sehgal K, Taylor F, Van Wees M, Li K, De Boo DW, Slater LA. What is the Safe Observation Period for Image-Guided Percutaneous Liver Biopsies? Cardiovasc Intervent Radiol 2024; 47:1327-1334. [PMID: 39078495 DOI: 10.1007/s00270-024-03800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/24/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Current observation period post-liver biopsy is typically 4 h. This study investigates the safety of reducing the observation period after percutaneous liver biopsy. METHODS Patients who underwent percutaneous liver biopsy between 2017 and 2022 in the Radiology Department of a tertiary centre were included in this retrospective, institutional review board-approved study. Patient demographics, procedure details and complication data were collected from the electronic medical records. Complications were graded according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification. Conditional survival probabilities were calculated for the 4-h observation period. RESULTS Among 1125 patients, 275 complications were seen; 255 grade 1, 15 grade 2 and five grade 3. Post-procedural pain represented 93% (256) of complications, whereas post-procedural haemorrhage occurred in 17 (6%) patients: 13 were of grade 2 severity requiring prolonged observation, and 4 were of grade 3 severity. Of these grade 3 complications, two required blood transfusion whereas two required embolization. A total of 215 (78%) complications occurred within 1 h, 244 (89%) within 2 h of observation. 16 (94%) of 17 post-procedural haemorrhages occurred within 2 h post-biopsy. If complication-free after 2 h, the probability of experiencing a complication within the next 2 h was 4%. CONCLUSION The majority of complications were identified within 2 h of observation. Complications recognised after this period were largely pain-related, with only one grade 3 complication seen (post-procedural haemorrhage).Our findings suggest 2 h of post-procedural observation may be safe. LEVEL OF EVIDENCE Level 2B, Retrospective Cohort Study.
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Affiliation(s)
- Kunal Sehgal
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia.
| | - Fergus Taylor
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Matthew Van Wees
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Kenny Li
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Diederick Willem De Boo
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
- Department of Radiology and Radiological Sciences, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee Anne Slater
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
- Department of Radiology and Radiological Sciences, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Aslan HS, Arslan M, Alver KH, Demirci M, Korkmaz M, Esen K, Turmak M, Deniz MA, Tekinhatun M, Kisbet T, Arıbal S, Önder H, Ozdemir M, Ozturk MH, Urfalı FE. Is a two-hour monitoring period sufficient and safe for patients undergoing ultrasound-guided percutaneous liver mass biopsy?: A prospective and multicenter experience. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39225264 DOI: 10.1002/jcu.23795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two-hour monitoring period. METHODS A multi-center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 ± 12.45 years (range 37-89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours. RESULTS Minor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late-onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late-onset major complications occurred in 37.5% (3/8) after 24 h. CONCLUSION The two-hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late-onset ones. Extending the post-biopsy recovery period does not significantly improve patient care.
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Affiliation(s)
- Halil Serdar Aslan
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Muhammet Arslan
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Kadir Han Alver
- Department of Radiology, Denizli State Hospital, Denizli, Turkey
| | - Mahmut Demirci
- Department of Radiology, Denizli State Hospital, Denizli, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Kutahya Healthy Science University Faculty of Medicine, Kutahya, Turkey
| | - Kaan Esen
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mehmet Turmak
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Muhammed Akif Deniz
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Muhammed Tekinhatun
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Tanju Kisbet
- Department of Radiology, University of Health Sciences, Prof Dr Cemil Tascıoglu City Hospital, İstanbul, Turkey
| | - Serkan Arıbal
- Department of Radiology, University of Health Sciences, Prof Dr Cemil Tascıoglu City Hospital, İstanbul, Turkey
| | - Hakan Önder
- Department of Radiology, University of Health Sciences, Prof Dr Cemil Tascıoglu City Hospital, İstanbul, Turkey
| | - Mustafa Ozdemir
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mehmet Halil Ozturk
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Peltekian KM. For fatty liver diseases, it is time to utilize non-invasive fibrosis tests to predict liver related events rather than just histological stages of hepatic fibrosis! Ann Hepatol 2021; 19:583-584. [PMID: 32853777 DOI: 10.1016/j.aohep.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Kevork Minas Peltekian
- Division of Digestive Care & Endoscopy, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 South Park Street, Victoria General Building Room 9-915, Halifax, B3H 2Y9, NS, Canada.
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Hepatic Squamous Cell Carcinoma Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Case Rep Gastrointest Med 2021; 2021:9939898. [PMID: 34327029 PMCID: PMC8277514 DOI: 10.1155/2021/9939898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Primary hepatic squamous cell carcinoma (SCC) is a rare malignancy with aggressive clinical features. This is the first case report of a primary hepatic SCC diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is a reliable and safe procedure for the histopathological diagnosis of liver lesions, even if the percutaneous approach is difficult due to ascites or hypervascularity at the puncture site. A 52-year-old man presented to the emergency department of a tertiary referral hospital with right upper quadrant abdominal pain and abdominal distention. Given the laboratory data, a diagnosis of spontaneous bacterial peritonitis (SBP) was made. Concurrently, an abdominal computed tomography (CT) scan revealed an 8 cm hypodense mass with delayed peripheral enhancement in the left hepatic lobe and paraaortic and perihepatic lymphadenopathy. As persistent ascites precluded percutaneous liver biopsy, we performed EUS-FNA of the liver mass, and the obtained specimen showed SCC. As otorhinolaryngological consultation and whole-body investigations, including chest CT, upper and lower endoscopy, and positron emission tomography CT, were all unremarkable except for the liver lesion and lymph nodes, a diagnosis of primary hepatic SCC with systemic lymph node metastasis was made. After treatment of SBP with antibiotics, we initiated chemotherapy concurrent with radiation therapy, adapted to his liver function. Radiation and three cycles of chemotherapy were not effective as the disease progressed, as seen on the follow-up CT scan, and the patient died of hepatic failure on the 134th day after diagnosis. In conclusion, EUS-FNA was a reliable method for tissue sampling in liver malignancies, particularly in selected patients with contraindications for percutaneous biopsy.
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do Amaral RH, Deprez FC, Dalla-Bona JP, Watte G, Roxo RS, Marchiori E, Hochhegger B. Need for analgesia after percutaneous liver biopsy: a real-life experience. Radiol Bras 2021; 54:165-170. [PMID: 34108763 PMCID: PMC8177684 DOI: 10.1590/0100-3984.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate variables affecting the need for analgesia after ultrasound-guided percutaneous liver biopsy performed on an outpatient basis. Materials and Methods This was a retrospective analysis of 1,042 liver biopsies performed between 2012 and 2018. The data collected included the age and sex of the patient, as well as self-reported pain in the recovery room, the pain treatment used, the indication for the biopsy, and the lobe punctured. As per the protocol of our institution, physicians would re-evaluate patients with mild pain (1-3 on a visual analog scale), prescribe analgesics for those with moderate pain (4-6 on the visual analog scale), and prescribe opioids for those with severe pain (7-10 on the visual analog scale). Results The main indications for biopsy were related to diffuse disease (in 89.9%), including the follow-up of hepatitis C (in 47.0%) and suspicion of nonalcoholic steatohepatitis (in 38.0%). Pain requiring analgesia occurred in 8.0% of procedures. Of the 485 female patients, 51 (10.5%) needed analgesia, compared with 33 (5.9%) of the 557 male patients (p < 0.05). The need for analgesia did not differ in relation to patient age, the lobe punctured, or the indication for biopsy (nodular or diffuse disease). The analgesic most commonly used was dipyrone (in 75.9%), followed by paracetamol alone (16.4%) and their combination with opioids (7.6%). Conclusion Ultrasound-guided percutaneous liver biopsy is safe and well tolerated. Postprocedural pain does not correlate with the lobe punctured, patient age, or the indication for biopsy and appears to affect more women than men.
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Affiliation(s)
- Ricardo Holderbaum do Amaral
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - João Pedro Dalla-Bona
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Guilherme Watte
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Rômulo Santos Roxo
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Bruno Hochhegger
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Bhogal N, Lamb B, Arbeiter B, Malik S, Sayles H, Lazenby AJ, Chandan S, Dhaliwal A, Singh S, Bhat I. Safety and adequacy of endoscopic ultrasound-guided random liver biopsy in comparison with transjugular and percutaneous approaches. Endosc Int Open 2020; 8:E1850-E1854. [PMID: 33269320 PMCID: PMC7671753 DOI: 10.1055/a-1274-9763] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an accepted technique for tissue acquisition. Traditionally, random LB has been performed with percutaneous (PC-LB) and transjugular (TJ-LB) approaches. The purpose of this study was to compare the safety profile and efficacy of EUS-LB, PC-LB, and TJ-LB. Patients and methods A retrospective analysis was performed at a tertiary academic medical center. Inclusion criteria for analysis were all adult patients who underwent EUS-LB since inception and TJ-LB/PC-LB over a 3-year span (June 2016 to June 2019). The primary outcome assessed was any adverse events. Secondary outcomes included technical success resulting in tissue acquisition and diagnostic adequacy of the sample for histologic analysis. Results A total of 513 patients were included for analysis. There were 135 EUS-LB, 287 PC-LB, and 91 TJ-LB. The most common indication for LB was abnormal liver function tests. For the primary outcome, the rate of adverse events was low with five reported (< 1 %). There were two in the EUS-LB group, two in the PC-LB group, and one in TJ-LB group, and this difference was not statistically significant ( P = 0.585). The technical success rate was 100 % in each group. The rate of diagnostic adequacy was 100 % in TJ-LB group and 99 % in both EUS-LB and PC-LB groups. This difference was not statistically significant ( P = 1.000). The most common histologic finding was non-specific changes (33.7 %) followed by non-alcoholic steatohepatitis (15.60 %). Conclusion In comparison with PC-LB and TJ-LB, EUS-LB has comparable safety profile, technical success rate, and diagnostic adequacy. EUS-LB should be considered as an option for random liver biopsy.
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Affiliation(s)
- Neil Bhogal
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Bernadette Lamb
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Benjamin Arbeiter
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Sarah Malik
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Harlan Sayles
- Department of Biostatistics, College of Public Health. University of Nebraska Medical Center, Nebraska, United States
| | - Audrey J. Lazenby
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Amaninder Dhaliwal
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Shailender Singh
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Ishfaq Bhat
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
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Ramai D, Zakhia K, Etienne D, Asarian A, Reddy M. Gerald Klatskin (1910-1986): A pioneer in hepato-biliary disorders and biopsy techniques. JOURNAL OF MEDICAL BIOGRAPHY 2020; 28:199-202. [PMID: 29998747 DOI: 10.1177/0967772018778028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The widespread use of liver biopsies underscores its utility and significance within the field of medicine. Dr. Gerald Klatskin's pioneering work on liver biopsy techniques, as well as his study of liver histopathology, paved the way for its diagnostic and therapeutic applications around the world. His attention to detail as well as meticulous account of hilar cholangiocarcinoma has had a lasting impact on the medical community. Eponymously, the tumor was named after him-Klatskin's tumor. Klatskin was also well known and respected for his commitment and devotion to his fellows who themselves went on to hold prestigious academic positions and make significant contributions of their own. The life and work of Klatskin documents a pioneering hepatologist and devoted teacher.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, USA
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Karl Zakhia
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Denzil Etienne
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, USA
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Lorentzen T, Nolsoe CP. The Role of US Contrast Agents in US-Guided Biopsy of Focal Liver Lesions: A Pictorial Review. Ultrasound Int Open 2019; 5:E11-E19. [PMID: 30599041 PMCID: PMC6251788 DOI: 10.1055/a-0770-4237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/15/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023] Open
Abstract
US-guided percutaneous biopsy of focal liver lesions (FLL) is a classic interventional procedure performed by almost all radiology units. Typically, an incidental focal finding on US or a focal indeterminate lesion diagnosed on CT, MRI or PET/CT is referred for US-guided biopsy for final diagnosis. The introduction of microbubble US contrast agents has overcome some of the limitations of standard US in diagnosing FLLs by displaying the microvasculature together with the US morphology, which has increased both the sensitivity and the specificity. The combination of CEUS and intervention is facilitated by newer US equipment providing split-screen mode, which displays the CEUS mode alongside the standard US mode simultaneously on a single monitor. The puncture line is displayed in both modes as well as on the monitor. The interventional device (i. e., biopsy needle) is typically best visualized in the standard US mode, while the characteristic tissue pattern in an FLL is typically best visualized in CEUS mode. There are 3 main categories in which CEUS has an impact on US-guided biopsy of FLLs: • CEUS improves the visualization of FLLs • CEUS improves the quality of the biopsy specimen from an FLL • CEUS reduces the need for US-guided biopsy of an FLL In the two first categories, CEUS is utilized simultaneously with US-guided biopsy to ensure correct needle targeting. In the last category, US-guided biopsy of the FLL becomes superfluous as a result of the CEUS examination.
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Affiliation(s)
- Torben Lorentzen
- Ultrasound Section, Division of Surgery, Dep of Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Dep of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation University of Copenhagen, Denmark
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Ahmed Y, Novak RD, Nakamoto D, Azar N. Is Ultrasound Fusion a Reasonable Replacement for Computed Tomography in Guiding Abdominal Interventions? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1131-1141. [PMID: 27091917 DOI: 10.7863/ultra.15.06007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare the diagnostic yield, complication rate, and procedure length of ultrasound fusion-guided liver biopsy to the diagnostic yield, complication rate, and procedure length of computed tomography (CT)-guided liver biopsy; to measure the average ionizing radiation dose that patients are exposed to during a typical CT-guided liver biopsy procedure; and to present relevant and interesting cases of ultrasound fusion-guided abdominal interventions to describe the efficacious use of the technology. METHODS A retrospective analysis of 63 patients who had image-guided liver biopsies performed at our institution was completed. Patient records were divided into 2 groups according to the type of image guidance used during the procedure (ultrasound fusion versus CT), and data were compared by the χ(2) test, Student t test, and Mann-Whitney U test. RESULTS The diagnostic yields and complication rates were not statistically significantly different between the modalities. The average procedure durations were significantly different: ultrasound fusion-guided biopsy, 31.63 minutes; compared to CT-guided biopsy, 61.67 minutes (P = .003). CONCLUSIONS Diagnostic yields and complication rates were comparable for ultrasound fusion and CT. However, the average procedure duration for an ultrasound fusion-guided liver biopsy was approximately half that of CT-guided liver biopsy, likely increasing both cost-effectiveness and patient satisfaction.
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Affiliation(s)
- Yasmine Ahmed
- University Hospitals, Case Medical Center, Cleveland, Ohio USA
| | - Ronald D Novak
- University Hospitals, Case Medical Center, Cleveland, Ohio USACase Western Reserve University School of Medicine, Cleveland, Ohio USA
| | - Dean Nakamoto
- University Hospitals, Case Medical Center, Cleveland, Ohio USA
| | - Nami Azar
- University Hospitals, Case Medical Center, Cleveland, Ohio USA
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