The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children
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ORIGINAL ARTICLE
The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children Gali Shapira-Zaltsberg 1,2 Joao G. Amaral 1,2
&
Bairbre Connolly 1,2 & Micheal Temple 1,2 & Dimitri A. Parra 1,2 & Afsaneh Amirabadi 1,2 &
Received: 27 March 2020 / Revised: 13 June 2020 / Accepted: 17 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Surveillance post image-guided percutaneous liver biopsy in children is variable. Objective The aim of this study was to assess the value of 4–6-h post-procedure ultrasonography (US) in detecting post-liverbiopsy hemorrhage. Materials and methods This prospective study included pediatric patients who underwent US-guided percutaneous liver biopsies. All children had a US study obtained pre-procedure and one obtained 4–6 h post-procedure; US examinations were deemed positive if abnormalities were present. We also reviewed any subsequent imaging that was performed within 7 days (late imaging) at the discretion of the referring team. Changes in US findings (ΔUS) were graded by two radiologists using a descriptive non-validated scale (none, minimal, marked). Hemoglobin (Hb) levels were assessed pre-procedure and 4 h postprocedure. The diagnostic accuracy of US changes for detecting post-procedural hemorrhage was calculated based on a drop in Hb >1.5 g/dL or Hb >15% from baseline (ΔHb). We used a Kruskal–Wallis test to correlate the ΔHb with ΔUS. Association between late-imaging and post-procedure US findings was tested using a chi-square test. We included 224 biopsies. Results The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post-procedure US in detecting post-procedure hemorrhage ranged 26.3–42.1%, 72.4–93.3%, 0.22–0.42, and 0.87–0.88, respectively. No significant association was seen between the ΔHb and sonographic findings (P=0.068). No significant difference was seen in the need for late imaging between children who did and those who did not have positive US findings (P=0.814). Conclusion The sensitivity and PPV of post-procedure US in detecting post-procedural hemorrhage are low. Our findings do not support routine post-procedure surveillance US. Keywords Biopsy . Children . Liver . Percutaneous liver biopsy . Ultrasound
Introduction Ultrasound (US)-guided percutaneous liver biopsy is considered a safe procedure, with major complications in children ranging 0.7–5.2% [1–3]. Clinically significant intraperitoneal hemorrhage is the most serious complication, usually presenting within the first 3 h post-procedure [4]. A 15–25% loss in blood volume is considered Class II hemorrhagic shock in
* Gali Shapira-Zaltsberg [email protected] 1
Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
2
University of Toronto, Toronto, ON, Canada
children [5], correlating with an approximately 15% drop in hemoglobin (Hb) level [6]. An increased number of needle passes, low platelet count (1
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