A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo

BACKGROUND AND AIMS Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is necessary to obtain core biopsy specimens for accurate diagnosis. The objective of this study was to directly compare the diagnostic yield of 2 EUS-LB fine-needle biopsy (FNB) systems in vivo. METHODS In this prospective, single center study, 108 adult patients undergoing EUS-LB over a 1-year period were included. Each EUS-LB consisted of an EGD, followed by EUS-guided biopsy of the left lobe of the liver sequentially using 2 different 19-gauge needles-the fork-tip (SharkCore) and Franseen (Acquire) FNB systems. Specimens were then reviewed by a GI histopathologist to determine diagnostic adequacy as well as number of complete portal tracts (CPT), specimen length and degree of fragmentation. RESULTS In 79.4% of cases, the fork-tip FNB system yielded a final diagnosis compared with 97.2% of the Franseen FNB specimens (p-value of <0.001). Mean complete portal tracts in the fork-tip FNB samples were 7.07 compared with 9.59 with the Franseen FNB samples (p-value of <0.001). Mean specimen length was 13.86 mm for the fork-tip FNB and 15.81 mm for Franseen FNB (p-value of 0.004). Cores were intact in 47.6% of fork-tip FNB samples and in 75.2% of Franseen FNB samples (p-value 0.004). CONCLUSIONS In EUS-guided liver biopsy, we found that the 19-gauge Franseen FNB system resulted in a statistically significant increase in diagnostic adequacy compared with biopsy using the fork-tip FNB system.