Transjugular liver biopsy in patients with diffuse liver disease: comparison of three cores with one or two cores for accurate histological interpretation

Background: Transjugular liver biopsy (TJLB) can be performed to obtain more than two cores safely. This advantage has not been evaluated in terms of diagnostic accuracy or grading/staging evaluation. Aim: To evaluate whether three separate cores of TJLB provide more histological information compared with two or one cores. Methods: Twenty‐three patients, who had three separate passes, with each core ≥7mm in length using a 19G Tru‐cut needle, were evaluated. Each TJLB was blindly coded; the pathologist randomly assessed: (a) each core separately covering the other two, (b) two cores simultaneously covering the third and (c) the three cores together for diagnostic yield, inflammation and fibrosis. Results: The mean TJLB length was 32±5.5mm. In 12 one‐core (52%) and 18 2‐core (78%) assessments, diagnosis (mainly cirrhosis) was made correctly in each core. The within‐patient standard deviations for one‐core vs two‐core assessment were similar for grading (0.42 and 0.47, respectively), but higher for staging (0.39 and 0.15, respectively). Staging was underestimated in assessing one‐core and less for two cores compared to three cores. Conclusion: Three non‐fragmented cores (each core ≥7mm in length) of TJLB can be considered a minimum requirement for histological assessment, giving better reproducibility in diagnosis as well as for inflammation and fibrosis.