Contrast-enhanced ultrasound-guided biopsy improved diagnostic accuracy in patients with hepatitis: A prospective multicenter study of 2056 patients
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Background Although ultrasound-guided biopsy of focal liver lesions is safe and has high diagnostic accuracy, the factors affecting the results of biopsy are unclear. To investigate factors affecting the accuracy of ultrasound-guided biopsy of liver focal lesions and developed a decision model for the management of biopsy results. Methods This study enrolled participants with focal hepatic lesions who underwent biopsy between March 2016 and August 2019 in nine hospitals in China. The frequency of accurate diagnosis was calculated. The variables were analyzed by multivariate logistic regression. Chi-squared automatic interaction detection was used to construct the prediction model. Results 2056 participants (1297 men, 376 women; mean age, 67.8 ± 10.8 years) were enrolled in the study with 2056 lesions (mean: 4.0±2.8 cm; range: 0.7-17.7 cm). 94.2% (1936/2056) of patients were accurately diagnosed. The accurate diagnosis rate of 2-3 passes was significantly higher than that of 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). The multivariate logistic regression showedthat no hepatitis [2.493 (1.512-4.110), P<0.001], CEUS-guided [1.884 (1.278-2.777), P=0.001], and biopsypass >1 [(1.811 (1.131-2.901), P=0.013] were independent predictors of accurate diagnoses. The decision tree model showed that in patients with hepatitiswho underwent CEUS-guided biopsy, the probability of an accurate diagnosis may be increased from 88.1% to 94.8% in patients with hepatitis who underwent US-guided biopsy. A 97.5% probability of diagnostic accuracy was obtained from patients without hepatitis who underwent US-guided biopsy. Conclusions CEUS-guided biopsy improves diagnostic accuracy in patients with hepatitis. 2-3 passes can achieve 95% accuracy, and a continued increase in the number of punctures did not improve diagnostic accuracy.
