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Improved tissue sections for medical liver biopsies: a comparison of 16 vs 18 g biopsy needles using digital pathology
  1. Timothy Palmer1,
  2. Izabela Georgiades2,
  3. Darren Treanor1,3,
  4. Alexander Wright3,
  5. Mushtaq Shah4,
  6. Randeep Khosla5,
  7. Judith I Wyatt1
  1. 1Department of Histopathology, St James's Hospital, Leeds, UK
  2. 2Department of Histopathology, Bradford Royal Infirmary, Bradford, UK
  3. 3University of Leeds Department of Pathology and Tumour Biology, University of Leeds, Leeds, UK
  4. 4Department of Radiology, St James's Hospital, Leeds, UK
  5. 5Department of Radiology, Bradford Royal Infirmary, Bradford, UK
  1. Correspondence to Dr Judith Wyatt, Department of Histopathology, Leeds Teaching Hospitals NHS Trust, St James's Hospital, Beckett Street, Leeds, Yorkshire LS9 7TF, UK; Judy.wyatt{at}


Background Most medical liver biopsies in the UK are now taken in radiology departments using 18 g biopsy needles. Subjectively, the resulting biopsies are narrow and fragile.

Aim To compare the quality of liver biopsy tissue sections obtained from 16 and 18 g biopsy needles.

Method Fifty consecutive routine medical liver biopsies obtained with 16 and 18 g needles, processed identically in the same laboratory, were measured using digital pathology software. We recorded their fragmentation, length, width, area and number of portal tracts.

Results Biopsies obtained with 16 g needles more often resulted in an intact core in tissue sections than those with 18 g needles (71% vs 24%, p<0.001) and were significantly wider (average width of tissue 0.88 vs 0.53 mm, p<0.001). The average total area of tissue per pass was 11.38 mm2 compared with 8.34 mm2 (p<0.001). The number of complete portal tracts per length of biopsy was very variable, but double for 16 vs 18 g biopsies. Routinely taking two passes with the 18 g needle compensated for the reduced area, but the resulting liver in tissue sections was fragmented and distorted.

Conclusions Our results support the routine use of 16 g rather than 18 g biopsy needles for routine ultrasound-guided medical liver biopsies. A second pass should be considered if the first biopsy core is short, especially for investigation of disease stage.


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