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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


  • 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

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.


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.


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.


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


  • Government Support - Non-U.S.