Menghini biopsy

Papini, E., Pacella, CJM., Rossi, Z., Bizzarri, G., Fabbrini, R., Nardi, F., Picardi, R. A randomized trial of ultrasound-guided anterior subcostal liver biopsy versus the conventional Menghini technique. J. Hepatol. 1991 13 291-297... 

In 1957 (not 1958 as is usually and wrongly quoted ) G. Menghini presented the first report on a new biopsy method using thin-walled, small calibre needles with a sharply slanting bevel and without a trocar, it was pos-... 

Both classical and modified types of biopsy needles are available suction needles (e. g. Menghini, Klatskin, and Jamshidi) and cutting needles (e. g. Vim-Silverman and Tru-cut) as well as spring-loaded needles. (12, 26, 86, 123, 129, 158, 162)... 

The swiftness of the intrahepatic puncture phase reduces the danger of bleeding. For this reason, a modified puncture technique with the Menghini needle has become established practice this involves a straight, forward movement, effected in a split second and performed at the same time as rapid aspiration suction followed by immediate withdrawal of the needle with continuing suction - a customary method of biopsy, which we have also found to be most satisfactory. With an experienced operator, the intrahepatic phase can be reduced to <1/10 second and, at the same time, aspiration suction can be remarkably increased. 

Intrahepatic biopsy is performed as swiftly as possible using standard instruments (available as a disposable set with a Menghini needle) this ensures the shooting of the biopsy needle into the liver after release of the spring tension (based on the principle of the spring-loaded needle). Today s high-speed biopsy sets are obtainable... 

One of the first major compilations of statistics was produced by H. Thaler in 1964 in 23,382 biopsies, the lethality rate was 0.017% and the complication rate 0.10%. (158) In evaluating 79,381 liver biopsies, H. Lindner (1967) calculated a lethality rate of 0.015% and a morbidity rate of 0.34%. (85) In 19,563 liver biopsies, E. WiLDHiRT registered no fatal cases with a morbidity rate of 0.089%. (176) In a multicentre study carried out by F. PiccioNiNo et af, 68,276 liver biopsies were recorded during the period 1973-1983 with a lethality rate of 0.009% and a morbidity rate of 0.21%. In this study, the Vim-Silverman and Tru-cut needle types proved to have the highest risk rate (0.31% to 0.34%). (121) Severe complications were found in 0.57% of cases by J.F. Cadranel et al. (15) Among 4,124 of our own biopsies (Menghini needle), we registered no cases of death whatsoever from 1961 to 1987 the complication rate was 0.15% (s. tab. 7.7). 

Each laparoscopy should aim at a visual assessment of the spleen in terms of (7.) size, (2.) colour, (i.) shape, and (4.) identifiable spleen diseases. Special mention should be made of capsular fibrosis, hyalinosis ( sugar-coated spleen ), tumours (e. g. Hodgkin s disease, retothelial sarcoma), tuberculosis, splenic cysts, splenic infarction (s. fig. 35.10) and splenic haematoma. Given appropriate positioning, the spleen is visible in 80% of cases. In the case of myeloproliferative diseases, a biopsy of the spleen (e. g. by means of the Menghini technique) can provide a definitive diagnosis, (s. pp 135,253) (s. figs. 11.1 14.7) (see chapter 11)... 

Providing there are no contraindications, each laparoscopy should incorporate a directed liver biopsy (H. Kalk et al., 1943). This is mainly performed by making a second incision in the right upper abdominal region below the costal arch in the area of the right liver lobe, as a rule using a Menghini needle. 

Colombo, M., del Ninno, E., de Franchis, R., de Fazio, C., Festorazzi, S., Ronchi, G., Tommasini, M.A. Ultrasound- assisted percutaneous liver biopsy superiority of the true-cut over the Menghini needle for diagnosis of cirrhosis. Gastroenterology 1988 95 487-489... 

Glaser, J., Mann, O., Siegmuller, M., Rausch, J. Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy. Ital. X Gastroenterol. 1994 26 338-341... 

Menghini, G. a) Un effetto progresso nella tecnica della puntura-biop-sia del fegato. Rass. Fisiopat. Clin. Ter. 1957 29 756-773. b) One-second needle biopsy of the liver. Gastroenterology 1958 35 190-199... 

It is of paramount importance for the morphological assessment of cirrhosis to know whether the liver material was obtained by (1.) post-mortem autopsy (when lymphohistiocytic inflammatory reactions are hardly detectable anymore) or (2.) biopsy with the aid of a Menghini needle (which only rarely yields fully assessable cirrhotic material). In contrast, biopsies carried out with a Silverman needle, for example, produce an adequately sized biopsy cylinder for assessment. 

CR ADDITIONS TO FRESH TISSUE OF HUMAN LIVER BIOPSIES TAKEN BY ASPIRATION WITH MENGHINI NEEDLE (M) AND WITH SURGICAL BLADE (WEDGE BIOPSIES) (W) (Versieck et al., 1982)... 

L.G., an 18 year old with granulomatous ileocolitis treated for 14 days with parenteral nutrition had a percutaneous menghini needle liver biopsy after clinical and chemical abnormalities suggested early hepatic disease. Fig. 2 represents a high power view of the biopsy specimen showing evidence of a focal round cell infiltrate with mild to moderate steatosis. 

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