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Abstract: SA-PO707

Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Sousanieh, George, Rush University Medical Center, Chicago, Illinois, United States
  • Whittier, William Luke, Rush University Medical Center, Chicago, Illinois, United States
  • Korbet, Stephen M., Rush University Medical Center, Chicago, Illinois, United States
Background

As percutaneous renal biopsies (PRB) are increasingly performed by interventional radiologists, an increase in the use of the smaller 18-gauge (G) automated biopsy needle has been observed. The use of smaller needles stands to compromise biopsy adequacy, ideally >20 glomeuli per biopsy. We compare the adequacy and safety of PRB with a 14, 16 and 18G automated needles.

Methods

PRB of native (N) kidneys (N-557) and transplant (T) kidneys (N-991) was performed by a Nephrologist or supervised Fellow at Rush University Medical Center from 1/2002 to 12/2018 using automated biopsy needles and with real-time ultrasound guidance. Baseline clinical and laboratory data, biopsy data (number of cores, glomeruli on light (LM) and immunofluorescence (IM) microscopy, total glomeruli (LM+IM) and total glomeruli per core (LM+IM)/cores)) and outcome data (hematoma on renal US 1-hr post-PRB, complications and procedures post-PRB) was collected prospectively. PRB with N14G (n=337) vs N16G (n=220) vs T16G (n=892) vs T18G (n=99) needles were compared. A P
value of <0.05 was significant.

Results

PRBs with an 18G needle were less likely to be performed by fellows (N14 vs N16 vs T16 vs T18G: 94% vs 85% vs 62% vs 22%, <0.0001). Despite this, PRB with an 18G needle was associated with the lowest number of glomeruli on LM (23±11 vs 20±10 vs 26±14 vs 16±10, <0.0001), IM (9±5 vs 9±5 vs 8±5 vs 6±, <0.0001) and LM+IM (32±13 vs 29±12 vs 34±6 vs 22±12, <0.0001). PRBs with an 18G needle were less likely to have >10 (99% vs 98% vs 98% vs 89%, <0.0001) and >20 (81% vs 79% vs 83% vs 48%, <0.0001) total glomeruli (LM+IM) per biopsy. The total glomeruli per core ((LM+IM)/cores) was also significantly less with an 18G needle (15±8 vs 14±6 vs 13±6 vs 10±5, <0.0001). A hematoma by renal US 1-hr post-PRB was similar for native biopsies (14G-35% vs 16G-29%, P=0.16), and transplant biopsy (16G-10% vs 18G-10%, P=0.71) irrespective of needle size. The complication rate for native biopsies (14G-8.9% vs 16G-7.2%, P=0.53), and transplant biopsies (16G-4.6% vs 18G-2.0%, P=0.30) and the transfusion rate for native biopsies (14G-7.7% vs 16G-5.9%, P=0.49), and transplant biopsies (16G-3.8% vs 18G-1.0%, P=0.25) were not significantly different irrespective of needle size.

Conclusion

The use of 18G biopsy needles significantly compromise the adequacy and thus, quality of the PRB while not significantly enhancing safety.

Funding

  • Government Support - Non-U.S.