The benefit of contrast-enhanced ultrasound in biopsies for focal liver lesions: a retrospective study of 820 cases

Objective This study compared the performance between ultrasound (US)- and contrast-enhanced US (CEUS)-guided liver biopsies and evaluated the benefit of CEUS in percutaneous biopsy for focal liver lesions (FLLs). Methods We performed a retrospective study of 820 patients with FLLs, who underwent percutaneous liver biopsy in our center between 2017 and 2019. The patients were divided into two groups based on whether US (n = 362) or CEUS (n = 458) used before a biopsy. The two groups were compared based on specimen adequacy for pathological diagnosis and diagnostic accuracy of liver biopsy. Stratification analysis was performed based on lesion and protocol characteristics to provide detailed information for selecting the imaging guidance for biopsy. Results Compared with the US group, the CEUS group yielded more acceptable samples (97.6% vs. 99.4%, p < 0.05) and improved diagnostic accuracy (92.6% vs. 96.4%, p < 0.05), and achieved better sensitivity (92.5% vs. 96.2%, p < 0.05) for liver biopsies, especially in FLLs >= 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. The CEUS group showed significantly higher accuracy compared with the US group pertaining to single-puncture biopsies (100% vs. 92.7%, p < 0.05) or biopsies with punctures <= 2 (97.6% vs. 94.3%, p < 0.05). Conclusion CEUS achieved an enhanced success rate for sampling and diagnostic accuracy of liver biopsies, especially in FLLs >= 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. CEUS can be used to decrease the number of punctures needed, which might increase the safety of liver biopsy.

Automated summary

CEUS has shown to have a higher success rate for sampling and diagnostic accuracy of liver biopsies compared to US, especially in cases of FLLs >= 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. CEUS can also reduce the number of punctures needed, potentially increasing the safety of liver biopsy.