A Comparison of Needle Types and Biopsy Techniques used in Liver Biopsies of Chronic Hepatitis B Patients

Liver biopsy has been performed since the end of the 19th century. Paul Ehrlich (Germany) performed liver biopsy for the first time in 1883, and Sheila Sherlock described percutaneous biopsy technique in 1945 (1, 2). Menghini performed biopsy with aspiration technique in 1958 (3). The first ultrasound (US) guided biopsy was performed in 1972 (4). Today, despite technological advancements such as US, computed tomography (CT) and magnetic resonance imaging (MRI), liver biopsy is still recognized as the gold standard method in order to establish the diagnosis, to evaluate the prognosis and to plan the treatment (5, 6). Major indications for liver biopsy include liver neoplasm, cholestatic liver disease, presence of abnormal hepatic function tests, chronic viral hepatitis, unexplained jaundice, or evaluation of suspicious drug reactions. In addition, liver biopsy is performed to evaluate rejection or to plan treatment in liver transplantation, and to confirm the diagnosis and prognosis in diffuse liver diseases (7, 8). Whereas contraindications for liver biopsy divided into two as absolute and partial. Absolute contraindications include noncooperative patients, severe bleeding disorder (INR > 1.6, platelet count < 50,000), Infection of the hepatic bed, and extrahepatic biliary obstruction, while partial contraindications are abdominal ascites, cyst hydatid, vascular lesions, amyloidosis and morbid obesity (8, 9). The most common complications following liver biopsy are pain and hemorrhage. Among the other rarely seen complications are pneumothorax, hemothorax, organ perforations, biliary peritonitis, infections, and hemobilia (8, 10). Liver biopsy is performed using three different methods as percutaneous, transvenous (transjugular, transfemoral) and surgical-laparoscopic biopsy. There are three different methods for percutaneous biopsies as palpation/percussion, radiologic marking, and real time imaging guidance (11, 12). Aspiration (Menghini,