Safety and diagnostic accuracy of ultrasound-assisted percutaneous liver biopsy in pediatric patients: a retrospective single-center study

Maria Rogalidou; Aglaia Zellos; Kalliopi Stefanaki; Amalia Patereli; Konstantina Dimakou; Paraskevi Galina; David Oikonomopoulos; Alexandra Papadopoulou

Authors Maria Rogalidou, Aglaia Zellos, Kalliopi Stefanaki, Amalia Patereli, Konstantina Dimakou, Paraskevi Galina, David Oikonomopoulos, Alexandra Papadopoulou.

Abstract

Background Liver biopsy remains essential for diagnosing and managing pediatric liver diseases, despite advances in noninvasive techniques. However, data on the current indications, diagnostic yield, and safety of ultrasound-assisted percutaneous liver biopsy in children are limited.

Methods We retrospectively analyzed 60 pediatric patients who underwent ultrasound-assisted percutaneous liver biopsy at Agia Sofia Children’s Hospital between January 2018 and September 2025. Data collected included demographics, laboratory values, biopsy indications, histopathology and complications. Biopsies were performed under anesthesia using an 18-G Tru-Cut needle with real-time ultrasound guidance. Hemoglobin and hematocrit were measured pre-procedure and at 4 and 24 h post-procedure. Specimen adequacy was assessed by core length and number of complete portal tracts (CPTs).

Results The mean patient age was 8.6 years (range 1 month to 17 years), with weights from 2.9-65 kg. Indications included persistent hypertransaminasemia, cholestasis, autoimmune and metabolic liver disease, and post-transplant evaluation. Mean biopsy length was 1.12 cm (range 0.5-2 cm), with a mean of 11 CPTs (range 4-17). Histopathology revealed autoimmune hepatitis (AIH) in 38.3%, AIH with primary sclerosing cholangitis in 13.3% of patients with inflammatory bowel disease, and other diagnoses in the remainder. No major complications or postprocedural bleeding occurred. Hemoglobin and hematocrit remained stable, and all specimens were adequate for histologic assessment.

Conclusions Ultrasound-assisted percutaneous liver biopsy with an 18-G needle is safe, and yields sufficient tissue for diagnosis in pediatric patients. It continues to be indispensable for the definitive diagnosis, staging, and management of diverse liver diseases in children.

Keywords Pediatric liver disease, ultrasound-assisted percutaneous liver biopsy, diagnostic accuracy, complications, histopathology

Ann Gastroenterol 2026; 39 (5): 581-587