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Purpose <p>To investigate the factors influencing ultrasound-guided liver biopsy accuracy and develop a decision model for managing biopsy results.</p> Materials and methods <p>This prospective study enrolled 2056 adult patients with focal hepatic lesions from nine Chinese hospitals. Diagnostic accuracy was calculated, and variables were analyzed using multivariate logistic regression. A prediction model was constructed using chi-square automatic interaction detection.</p> Results <p>This study enrolled 2056 participants (1297 men, 759 women; mean age, 67.8 ± 10.8&#xa0;years) with 2056 biopsied lesions (mean ± standard deviation: 4.0 ± 2.8&#xa0;cm; range 0.7–17.7&#xa0;cm), and 94.2% were accurately diagnosed. Two to three biopsy passes were significantly more accurate than one pass (95.1% vs. 87.3%, <i>P</i> &lt; 0.001) and comparable to the accuracy of &gt; 3 passes (95.1% vs. 93.2%, <i>P</i> = 0.408). Independent predictors of accurate diagnoses included absence of cirrhosis [2.428 (1.457–3.741), <i>P</i> &lt; 0.001], CEUS guidance [1.899 (1.288–2.801), <i>P</i> = 0.001], and number of biopsy passes &gt; 1 [1.775 (1.103–2.855), <i>P</i> = 0.018]. The predictive decision tree model demonstrated that for cirrhotic patients who underwent CEUS-guided biopsy, the probability of an accurate diagnosis increased from 88.3% (when US-guided biopsy was used) to 93.3%. Conversely, in noncirrhotic patients undergoing US-guided biopsy, a diagnostic accuracy probability of 96.4% was observed. The overall prediction accuracy of the model was 94.4%.</p> Conclusion <p>CEUS-guided biopsy enhances diagnostic accuracy in cirrhotic patients, whereas US-guided biopsy is highly accurate in noncirrhotic patients. Two to three needle punctures are sufficient for 95% accuracy, with no additional improvement from more punctures.</p>

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Improving diagnostic accuracy in cirrhotic patients: a comprehensive multicenter analysis of contrast-enhanced ultrasound-guided biopsy in a large cohort of 2056 patients

  • 期刊论文

  • 发表日期：

    2025年7月1日

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  • Binbin Jiang,
  • Xiang Jing,
  • Yuxiang Wang,
  • Xiaolin Zhu,
  • Jing Wang,
  • Ruiqing Du,
  • Bin Lv,
  • Kefeng Wang,
  • Zhixiang Gao,
  • Kun Yan

摘要

Purpose

To investigate the factors influencing ultrasound-guided liver biopsy accuracy and develop a decision model for managing biopsy results.

Materials and methods

This prospective study enrolled 2056 adult patients with focal hepatic lesions from nine Chinese hospitals. Diagnostic accuracy was calculated, and variables were analyzed using multivariate logistic regression. A prediction model was constructed using chi-square automatic interaction detection.

Results

This study enrolled 2056 participants (1297 men, 759 women; mean age, 67.8 ± 10.8 years) with 2056 biopsied lesions (mean ± standard deviation: 4.0 ± 2.8 cm; range 0.7–17.7 cm), and 94.2% were accurately diagnosed. Two to three biopsy passes were significantly more accurate than one pass (95.1% vs. 87.3%, P < 0.001) and comparable to the accuracy of > 3 passes (95.1% vs. 93.2%, P = 0.408). Independent predictors of accurate diagnoses included absence of cirrhosis [2.428 (1.457–3.741), P < 0.001], CEUS guidance [1.899 (1.288–2.801), P = 0.001], and number of biopsy passes > 1 [1.775 (1.103–2.855), P = 0.018]. The predictive decision tree model demonstrated that for cirrhotic patients who underwent CEUS-guided biopsy, the probability of an accurate diagnosis increased from 88.3% (when US-guided biopsy was used) to 93.3%. Conversely, in noncirrhotic patients undergoing US-guided biopsy, a diagnostic accuracy probability of 96.4% was observed. The overall prediction accuracy of the model was 94.4%.

Conclusion

CEUS-guided biopsy enhances diagnostic accuracy in cirrhotic patients, whereas US-guided biopsy is highly accurate in noncirrhotic patients. Two to three needle punctures are sufficient for 95% accuracy, with no additional improvement from more punctures.