Comparison of Endoscopic Ultrasound‐guided Tissue Acquisition and Percutaneous Liver Biopsy for Diagnosing Focal Liver Lesions: A Retrospective Single‐Center Study

Background and Aim Accurate diagnosis of focal liver lesions (FLLs) is crucial for determining the appropriate treatment strategies. Although percutaneous liver biopsy (PLB) is the standard diagnostic procedure, it has limitations, particularly for difficult‐to‐access lesions. Endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) is an emerging diagnostic alternative. This study aimed to compare the diagnostic accuracy, safety, and histological adequacy of EUS‐TA with those of conventional PLB for diagnosing FLLs. Methods This single‐center retrospective study included 70 patients who underwent EUS‐TA ( n = 28) or PLB ( n = 42) for FLLs between January 2019 and February 2024. Diagnostic accuracy, sensitivity, specificity, tissue adequacy, and adverse events were assessed. Results The technical success rate was 100% in both groups. EUS‐TA showed 100% sensitivity, 100% specificity, and 100% accuracy without false negatives. PLB showed 88.6% sensitivity, 100% specificity, and 90% accuracy with four false negatives. Both methods provided sufficient specimens for immunohistochemistry. Adverse events were rare. However, postprocedural pain (7.1%) and 1 case of needle tract seeding (2.4%) occurred in the PLB group, whereas one bleeding event (3.6%) occurred in the EUS‐TA group. EUS‐TA was mainly used for left and caudate lobe lesions. Conclusions EUS‐TA appears to be a safe and accurate option for FLLs, particularly when percutaneous access is difficult. In clinical practice, EUS‐TA and PLB may serve complementary roles, and their combined use could help improve diagnostic accuracy. Prospective studies are needed to clarify specific indications.