Percutaneous Liver Biopsy in Children: Comparing Complication Rates and Diagnostic Adequacy of 18G and 20G Needles
2Department of Diagnostic Radiology, Rabin Medical Center, Hasharon and Beilinson Hospitals, Israel
Purpose: Percutaneous liver biopsy is a cornerstone of pediatric liver disease management, yet data on optimal coaxial needle gauge in children remain limited. Smaller-gauge needles may theoretically improve safety but could compromise diagnostic yield. This study compared the safety and diagnostic adequacy of ultrasound-guided percutaneous liver biopsies performed with semi-automated 20G versus 18G coaxial needles in pediatric patients.
Materials and Methods: In this retrospective cohort study, consecutive patients aged 1–19 years who underwent percutaneous non-targeted liver biopsy at a tertiary center between 2006 and 2012 were included. Demographics, technique parameters (needle gauge, core number, tract embolization), and complications were analyzed. Procedural success required a definitive pathology report with ≥7 portal tracts, the accepted threshold for reliable histologic diagnosis. Complications were classified per Society of Interventional Radiology guidelines.
Results: 320 biopsies were performed in 260 patients (44.6% female; mean age 7.4 ± 6.0 years). Leading indications were post-transplant surveillance (28.4%) and unexplained liver enzyme elevation (22.5%). Biopsies used 18G (n=148, 46.3%) or 20G (n=172, 53.7%) needles. Diagnostic and clinical adequacy was achieved in 100% of procedures, directly influencing management in 39.7% of cases. Overall complication rate was 5.3% (3.4% minor, 1.9% major), with no procedure-related mortality. Complication rates were numerically higher in the 20G group, likely reflecting selection bias toward younger or higher-risk patients, but the difference was not statistically significant. The 20G needle was associated with significantly reduced need for post-biopsy tract embolization.
Conclusion: No statistically significant differences in complication rates or diagnostic adequacy were found between 18G and 20G coaxial needles for pediatric liver biopsy. The 20G needle offers high diagnostic yield and reduces tract embolization needs, while both gauges remain acceptable options. Needle gauge selection should be individualized based on patient characteristics, bleeding risk, and clinical indication rather than defaulting to smaller gauges across all pediatric age groups.