Liver Biopsy: since there is so much discussion, thought I would add a different perspective.
Our center does a medium to high number of liver tranplants. Within the last few years we have ramped up the number of biopsies we perform. It is the number one cause iatrogenic pneumothorax for our entire (sic)health system. This has been a great concern; particularly when you consider only attending interventionalists perform the biopsies under realtime image guidance vs. interns placing central lines without imaging.
The impact is real and twofold. Patients frequently require chest tube placement and the event is reportable as a sentinel event.
There is no way pneumothorax is a reportable sentinal event.
There is no way you have less collapsed lungs from lung biopsies compared to liver biopsies, comparing hep c and for specific liver masses.
I'm guessing you are a nurse (no dig as my wife is one), secretary or allied health provider of some sort.
I do 3-4 biopsies a day for the last 25 years. I'm guessing I've done atleast 15,000 bipsies of various organs and masses. I biopsy hep C patients (liver biopsy), also patients with specific liver lesions, as well as lung mass patients (sticking the needle directly into a specific mass in the lung).
For Hep C patients where you can biopsy anywhere in the liver (as opposed to specific liver masses where very rarely you have to traverse the lung (hence the risk of lung collapse) to get to the specific liver mass and mak a diagnosis.
Collapsed lung rate for hep C patients has to be under 1/500 because you can go anywhere in the liver. Bleeding issues are way much more common with Hep C liver biopsies and are certainly more serious. Bleeding issues are also fairily rare. Once every year or two someone is hospitalised or needs a transfusion from a liver biopsy for Hep C.
Lung masses, you stick the lung multiple times and the lung collapse rate is still only around 25% of which less than half need a chest tube. A chest tube is an after thought as the primary goal is to get lung tissue to make a diagnosis so the patient knows whether they have something serious or not. A chest tube is usually in overnight and then removed.
The bigger problemn with Hep C liver biopsies is you are taking a sliver of liver and hoping it represents what is happening in the remainder of the liver. A good guess, maybe or maybe not.
I think Biomarkers are probably more accurate about the whole livers health. The FDA likely realizes this and may not ask for liver biopsy comfirmations for all the reasons stated above.
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