US-Guided percutaneous core needle biopsy via the complete transhepatic approach: a reliable option for deep abdominal lesions.

Abstract

Purpose: To assess the feasibility, reliability, and diagnostic performance of ultrasound (US)-guided percutaneous core needle biopsy (PCNB) performed via the complete transhepatic approach (CTHa) for abdominal lesions.

Materials and methods: This study included 71 patients (31 males, 40 females) with a mean age of 64.8 ± 13.9 years (range: 19-93) who underwent US-guided PCNB via the CTHa for abdominal lesions between January 2014 and December 2024. All biopsies were performed by interventional radiologists with at least five years of experience using a coaxial system and an 18-gauge automatic biopsy device. Patients were assessed for technical success, diagnostic yield, and complications, which were classified as major or minor based on the Society of Interventional Radiology (SIR) guidelines.

Results: Tissue samples were successfully obtained in all cases, achieving a 100% technical success rate. Adequate material for pathological diagnosis was available in 63 of 71 patients (88.7%), while a definitive diagnosis could not be established in 11.3% of cases. Diagnostic yield was significantly influenced by lesion type (solid or mixed with cystic components) and anatomical location (p = 0.001 and p = 0.032, respectively). Complications occurred in 12.7% of patients, including 11.3% minor and 1.4% major complications. Univariate logistic regression analysis identified a history of malignancy, lesion size along the biopsy path, and the length of liver parenchyma traversed as significant predictors of complications (p = 0.012, 0.027 and 0.003 respectively). In the multivariate model, liver parenchyma length remained the only independent risk factor (p = 0.023).

Conclusion: US-guided PCNB via the CTHa is a safe and effective option for abdominal lesions when extrahepatic access is not feasible. While longer liver tissue traversal increases the risk of minor complications, no major adverse events were observed. Careful procedural planning and consideration of lesion location and cystic content are essential to optimize diagnostic yield.