Sonography-Guided Percutaneous Liver Biopsies in Children

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of sonography-guided percutaneous core needle liver biopsy in infants and children. MATERIALS AND METHODS. We conducted a retrospective analysis of all patients who underwent sonography-guided percutaneous core needle liver biopsies over a 7.5-year period by pediatric interventionalists at a single tertiary center. RESULTS. A total of 597 procedures were performed in 470 patients (270 male and 200 female), with a mean age of 10.5 years (age range, 1 month-21 years). The main indications for biopsies were abnormal liver enzymes (n = 129, 21.6%), grading and staging of chronic hepatitis B or C (n = 105, 17.6%), evaluation of transplanted liver (n = 111, 18.6%), iron overload (n = 73, 12.2%), miscellaneous other diffuse parenchymal abnormalities (n = 124, 20.7%), and focal hepatic lesions (n = 55, 9.2%). The procedures were performed either under sedation (n = 311, 52.1%) or general anesthesia (n = 286, 47.9%). Diagnostic yield was obtained in 596 biopsies (99.8%) from an average of 2.4 cores in patients with diffuse disease (n = 541, 90.6%) and 6.5 cores in patients with focal disease (n = 55, 9.2%). Ten patients (1.7%) experienced a major complication, including pneumothorax (n = 1, 0.2%), abdominal wall pseudoaneurysm (n = 1, 0.2%), and symptomatic bleeding (n = 8, 1.3%). Five of these children required transfusion, two were only admitted for observation, and one required surgical evacuation. There were no procedure-related deaths. Minor complications (n = 49, 8.2%) included asymptomatic subcapsular hematoma (n = 35) and stable small hemoperitoneum (n = 9). CONCLUSION. Sonography-guided percutaneous core liver biopsy is a safe and effective procedure in children that has a high diagnostic yield and very low complication rate.