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Abstract: PO2243

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
  • Rodby, Roger A., Rush University Medical Center, Chicago, Illinois, United States
  • Peev, Vasil, 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 automated biopsy needle has been observed. The use of smaller gauge needles stands to compromise adequacy, ideally >20 glomeruli per biopsy. We compare the adequacy and safety of PRB with a 14, 16 and 18-gauge automated needles.

Methods

PRB of 592 native (N) and 1023 transplant (T) kidneys was performed by a nephrologist or a supervised nephrology fellow at Rush University Medical Center from 1/2002 to 12/2019 using real-time ultrasound guidance. Baseline clinical and laboratory data, biopsy sample data (number of cores, total glomeruli per biopsy (glomeruli on light + immunofluorescence + electron microscopy) and total glomeruli per core) and outcome data (hematoma on renal US 1-hr post-PRB and complications requiring a transfucion or procedure post-PRB) were collected prospectively. PRB with N14g (n=337) vs N16g (n=255) and T16g (n=892) vs T18g (n=131) needles were compared. A P value of <0.05 was significant.

Results

PRB with an 18g needle yielded the lowest number of total glomeruli per biopsy (N14g vs N16g: 33±13 vs 29±12, P<0.01 and T16g vs T18g: 34±16 vs 21±11, P <0.0001 and N16g vs T18g, P <0.001). PRBs with 18g needle were also less likely to have >20 total glomeruli per biopsy (N14g vs N16g: 85% vs 82%, P=0.4 and T16g vs T18g: 83% vs 46%, P<0.0001). The number of cores per biopsy was: N14g-2.3±0.7, N16g- 2.2±0.6, T16g-2.8±0.7 and T18g- 2.2±0.6. Adjusting for the number of cores obtained, the total glomeruli per core was significantly less with 18g needle (N14g vs N16g: 15±8 vs 14±6, P=0.1 and T16g vs T18g: 13±6 vs 10±5, P<0.001 and N16g vs T18g, P <0.001). A hematoma by routine screening renal US 1-hr post-PRB was similar for native (14g-35% vs 16g-29%, P=0.2), and transplant biopsies (16g-10% vs 18g-9%, P=0.9) irrespective of needle size. The complication rate for native (14g-8.9% vs 16g-7.1%, P=0.5), and transplant biopsies (16g-4.6% vs 18g-1.5%, P=0.2) as well as the transfusion rate for native (14g-7.7% vs 16g-5.8%, P=0.4), and transplant biopsies (16g-3.8% vs 18g-0.8%, P=0.1) were not significantly different irrespective of needle size.

Conclusion

The use of the smaller, 18g biopsy needle compromises the adequacy and thus, quality of the PRB while not enhancing safety.