Ultrasonically guided fine needle puncture of focal liver lesions. Review and personal experience.

Despite recent advances in diagnostic imaging of the liver, the management of a patient with focal liver lesions often depends on obtaining tissue for histological diagnosis. Ultrasound guided fine needle biopsy is recommended as a safe and reliable method for cyto-histological confirmation of suspected hepatic malignancy. A fine needle is conventionally defined as having an outer diameter < or = 0.9 mm or > or = 19 G. Ultrasound guided fine needle aspiration cytology is found reliable for diagnosing malignancy. Limitations of this method are inadequate sampling and limited value in diagnosis of well-differentiated malignant tumours and benign tumours. Ultrasound guided fine needle cutting biopsy allows to obtain tissue for histological examination according to the Menghini technique. Both methods have high sensitivity, specificity and accuracy in detecting malignancy. In a personal series of 50 fine needle aspiration cytologies, a sensitivity for malignancy of 87% was obtained, with a specificity of 100%. The insufficient sampling rate, however, was 10%. Ultrasound guided fine needle trucut biopsy combines the advantages of a fine needle and a better sampling quality; a lower insufficient sampling rate can be expected without increase in complication rate. Despite the availability of numerous manually operated or (semi-) automated devices, little data have been published up to now on liver lesions. In our hands, it has proven to be a safe and reliable method, with low insufficient sampling rate, allowing correct identification of primary liver malignancies, correct suggestion of the primary source of the majority of metastases and correct identification of most benign liver lesions. Therefore it is considered as the method of choice when focal noncystic liver lesions are to be biopsied.