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Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine

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Abstract

Purpose

To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate.

Methods

Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001–September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher’s exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques.

Results

Aggressive biopsies constituted 11.6% of biopsy events (N =579/5011). The incidence of major hemorrhage with <4 passes was 0.4% (N =18/4432) and with ≥4 passes 1.2% (N =6/579). In univariable models, aggressive biopsy was significantly associated with major hemorrhage (OR 3.0, 95% CI 1.16–6.92, p =0.025). After adjusting for gender and platelet count, the association was not significant at the p =0.05 level (OR 2.58, 95% CI 0.927–6.24, p =0.067). The rate of major hemorrhage in the coaxial biopsy technique group was 1.4% (N =3/209) compared to 1.1% (N =4/370) in the noncoaxial biopsy technique group, which was not a significant difference (p =0.707).

Conclusions

Although aggressive image-guided liver mass biopsies had an increased incidence of major hemorrhage, the overall risk of bleeding remained low. The benefit of such biopsies will almost certainly outweigh the risk in most patients.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    James H. Boyum, Thomas D. Atwell, Darci J. Wall, Adam J. Weisbrod & A. Nicholas Kurup

  2. Department of Medical Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Aaron S. Mansfield

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Sarah E. Kerr & Kandelaria M. Rumilla

  4. Department of Clinical Statistics, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Tina M. Gunderson

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  1. James H. Boyum
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  2. Thomas D. Atwell
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Corresponding author

Correspondence to James H. Boyum.

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Funding

Funding for data management and analysis was provided by the Mayo Clinic Radiology Research Committee.

Conflict of interest

The authors declare that they have no conflict of interest.

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Boyum, J.H., Atwell, T.D., Wall, D.J. et al. Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine. Abdom Radiol 44, 2067–2073 (2019). https://doi.org/10.1007/s00261-018-1637-6

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