Letter to the Editor: “Targeted and non-targeted liver biopsies carry the same risk of complication”

by Katja N De Paepe, Nicos Fotiadis (nicos.fotiadis@rmh.nhs.uk )

Targeted and non-targeted liver biopsies carry the same risk of complication

Dear Editor,

We have read with great interest the publication by Maheux A et al [1] regarding the complication rates of targeted and non-targeted liver biopsies. The authors, in contrast to most previous studies [2, 3], conclude that there is no significant difference in the complication rates. However, there is a methodological flaw in the definition of complications in this study; all grade I complications are defined as “marked symptoms”. The 134 patients who had post-procedural imaging to investigate their symptoms (including 41 CTs and 10 patients who had both CT and ultrasound) should be classified as grade I complications based on the classification of complications by the European and American Society of Interventional Radiology [4, 5] and the classification of complications in the surgical literature [6]. There was a definite deviation from the standard post-procedure course for this group of patients, which includes patients with a haemoglobin drop, hypotension, fever, GI haemorrhage, cholestasis, and pain. When taking into consideration these patients with “marked symptoms” and defining them as grade I adverse events, the overall complication rate is higher in the targeted-liver biopsy group in line with most previous studies [2, 3]. The most serious complications though, as presented by Maheux A et al [1], were similar in the two groups, which is novel knowledge and adds to the existing evidence in the field.

Standardisation of the terminology and definition of complications in the interventional radiology literature is of paramount importance for comparison of results, quality assessment, and accumulation of scientific evidence.