Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion

Table 1 Literature data: Diagnostic accuracy, success rate, adverse events, and complications of endoscopic ultrasound guided biopsies for liver lesions

Ref.	Study design	Lesions/patients, n	Results	Succes rate, adverse events
DeWitt et al[9], 2003	Large study	77 SLT; FNA	77 liver specimens, 25 benign (33%); 45 malignant (58%), and 7 nondiagnostic (9%)	Sensitivity for the diagnosis of malignancy ranged from 82% to 94%
Lee et al[11], 2015	Prospective study	21 SLT with nonconclusive diagnosis after percutaneous biopsy	21 lesions were malignant	Diagnostic accuracy-85.7% (diagnosis of malignancy in 19 cases)
Oh et al[12], 2017	Study liver masses	47 patients with liver masses FNA; 24 left lobe (51.1%); 13 right lobe (27.7%); 10 both lobe (21.3%); size of lesion, median, 26 mm (15-37); number of needles passes 3	9 benign (19.15%); 38 malignant (80.95%); technical success 97.9%; EUS-FNA was diagnostic in 38 of 42 patients (90.5%); technical success similar in both lobs (100% left lobe vs 94.1% right lobe)	Adequate specimen higher in left lobe (93.3% vs 82.4%); diagnostic accuracy not different between lobes (89.3% vs 92.9%); no complications
Temnykh et al[13], 2020	Prospective study	180 solid lesions; FNB (Franseen) vs 183 solid lesions; FNA (acquire) 32 liver lesions (23 FNA, 9 FNB)	37.4 min (FNB) vs 44.9 (FNA) min; 2.9 passes FNB vs 3.8 passes FNA	Cytologic diagnostic yield 98.3% (FNB) vs 90.2% (FNA), P = 0.003; adverse events 1.1% (FNB) vs 0.5% (FNA)
Akay et al[14], 2021	Retrospective study	25 patients with SLT, FNA 22 G, 1 pass	16 malignancies: 7 HCC, 1 CCA, 1 adenoma, 6 metastasis, 1 GB cancer infiltration; 3 benign (3 steatosis), 3 inadequate materials	Diagnostic accuracy 86.30%, success rate 88.00% (22 patients), 94.45% aspirate sufficiency, 86.30% biopsy sufficiency rate
Chen et al[15], 2020	Retrospective study	34 patients with cirrhosis and suspected left lobe HCC, FNB	30 adequate biopsies specimens; 25 patients confirmed HCC, 5 benign	Se/Sp/PPV/NPV, 88.0%/100.0%/100.0%/62.5%
Chen et al[16], 2014	Retrospective study	4312 patients with suspected HCC with AFP under 200ng/dL FNA; 1756 underwent FNA	1590 malignant (1145 primary liver neoplasm: HCC 1067, CCA 63, HCC- CCA 8, hepatoblastoma 1, lymphoma 6, metastasis neoplasms 75), 166 benign	112 false negative, Se 92.00%, Sp 96.00%, PPV 100.00%, NPV 59.71%; overall accuracy 93.62%; complications: 4 implantation metastasis, 6 hemorrhage
Zhang et al[17], 2020	Retrospective study	624 malignant liver cases FNB	448 metastases(71.8%), 97 HCC (28.2%), 73 CCA, 3 HCC-CCA, 58 NET (11.7%), 24 SSC (3.8%); embryonal sarcoma, hepatoblastoma, leiomyosarcoma	30 different types of malignant tumors
Ichim et al[40], 2019	Prospective study	48 patients with malignant SLT FNA 22 G	47 malignancies, 1 insufficient, metastasis pancreatic ADK 26% CCA 17%	Diagnostic yield 98%, 83% from left lob, 17% from right lob, no adverse events/complications
Gheorghiu et al[41], 2022	Head-to-head study, prospective trial	38 SLT; 22 G FNB vs 22 G FNA	25 malignant lesions (14 metastases and 11 primary liver tumors); 6 benign lesions (abscesses); 7 inconclusive	Diagnostic rate for FNB-93.9%; insufficient core 4.0% (FNB) vs 20.0% (FNA)
Choi et al[65], 2017	Liver study	28 patients with SLT located in the left liver lobe FNB	KRAS mutation was analyzed	Diagnostic accuracy for malignancy 89.3%; adding KRAS diagnostic accuracy 96.4%

FNA: Fine needle aspiration; FNB: Fine needle biopsy; SLT: Solid liver tumor; HCC: Hepatocarcinoma carcinoma; CCA: Cholangiocarcinoma; GB: Gallbladder; Se: Sensibility; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predicting value; AFP: Alfa feto protein; NET: Neuroendocrine tumor; ADK: Adenocarcinoma; SSC: Squamous cell carcinoma.