To study the application value of biopsy under the guidance of contrast-enhanced ultrasound (CEUS) in hepatic space-occupying lesions.

Totally 42 patients who were planned to receive ultrasound guided percutaneous biopsy for liver space-occupying lesion in First Affiliated Hospital, Zhejiang University School of Medicine from September 2016 to November 2017 were included in this study. All patients underwent CEUS before biopsy, and the targeted percutaneous biopsy for liver occupying lesions was conducted under the guidance of CEUS. The biopsy tissues were satisfied if enough for the pathology diagnosis. The pathological diagnosis of malignancy was based on the biopsy findings or surgical results. If no malignancy was found in pathology, the lesions were clinically considered to be benign based on the findings of imaging examinations [computer tomography (CT), magnetic resonance imaging (MRI), CEUS, positron emission tomography (PET), emission computed tomography (ECT), and angiography], tumor markers [alpha fetal protein (AFP), carbohydrate antigen 199 (CA199), etc.], and no change in follow-up more than 3 months.

Under the guidance of CEUS, the areas with malignant enhancement pattern were selected for biopsy. The puncture times were 1 to 2 with an average of (1.74±0.21) times. The biopsy pathology diagnosis of 42 patients with liver space-occupying lesions in the study was: hepatocellular carcinoma 19 cases, cholangiocarcinoma 3 cases, metastatic liver cancer 9 cases, liver nodular cirrhosis 3 cases, inflammation 5 cases, cavernous hemangioma 1 case, focal nodular hyperplasia 1 case, and atypical hyperplasia nodules 1 case. The puncture success rate of CEUS guided biopsy was 100% (42/42), the positive puncture rate 100% (42/42), and the diagnosis coincidence rate 100% (42/42). All patients in this study had no complications such as perihepatoenteric space or pelvic bleeding, pneumothorax, needle implantation, bile leakage, or major vascular injury after biopsy.

CEUS can show microvascular bood-supply of liver space-occupying lesions, accurately determine the active areas and necrosis/liquefied areas, confirm the tiny lesions that conventional ultrasound cannot detect, and thus can improve puncture success rates, the positive puncture rates, the diagnosis coincidence rates and malignant lesion pathological diagnosis rates.