Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine

Purpose To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate. Methods Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001–September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher’s exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques. Results Aggressive biopsies constituted 11.6% of biopsy events ( N =579/5011). The incidence of major hemorrhage with