Comparative Analysis of Endoscopic Ultrasound–Guided Fine Needle Liver Biopsy with Percutaneous and Transjugular Liver Biopsy: Emphasis on Morphologic Analysis

The use of endoscopic ultrasound-guided fine needle liver biopsy (EUS-FNLB) has been rising. However, limited data are available comparing the quality of biopsy specimens obtained via EUS-FNLB with those from traditional methods, such as percutaneous liver biopsy (PC-LB) and transjugular liver biopsy (TJ-LB). We sought to assess the microscopic quality of liver biopsy specimens obtained through EUS-FNLB compared to PC-LB and TJ-LB. A retrospective, cross-sectional study was conducted on liver biopsy specimens collected via EUS-FNLB, PC-LB, and TJ-LB at our institution between April 2022 and August 2024. Demographic, clinical, and histopathologic data were extracted from medical records and pathology reports. Specimen quality was assessed using the American Association for the Study of Liver Diseases criteria for adequate biopsy length and portal tract count (≥2 cm and ≥11 portal tracts), as well as the presence of fragmentation and the overall tissue yield. A total of 160 patients were included, with 85 EUS-FNLB, 50 PC-LB, and 25 TJ-LB. EUS-FNLB demonstrated the greatest median aggregate length (3.5 cm) and the highest median number of complete portal tracts (CPT) (18 CPT) compared to PC-LB (1.9 cm; 13 CPT) and TJ-LB (2.4 cm; 12 CPT). Although EUS-FNLB showed the highest rate of tissue fragmentation (62%), this approach still led to an adequate diagnosis in 99% of patients. EUS-FNLB may provide superior specimen quality in terms of aggregate length and CPT count compared to PC-LB and TJ-LB, although it results in a higher degree of tissue fragmentation.