Coaxial liver biopsy with tract electrocauterization: technique and outcomes in high-risk patients with suspected hepatocellular carcinoma

PURPOSE: To evaluate the safety and efficacy of a technique combining coaxial biopsy with electrocauterization of the biopsy tract in high-risk patients with suspected hepatocellular carcinoma (HCC). METHODS: We retrospectively analyzed 102 liver biopsies performed in 99 patients (78 males, 21 females) with suspected HCC using a 17-gauge coaxial introducer needle and 18G automatic biopsy needle. After sample collection, the biopsy tract was sealed by applying monopolar electrocauterization to the coaxial needle during its removal. Patient demographics, procedural details, contraindications (INR > 1.5, platelet count < 50,000/mm³, ascites, antiplatelet/anticoagulant use), pathology results, and complications were recorded. Follow-up imaging (range: 18-360 days) was systematically reviewed to identify potential tumor seeding along the biopsy tract. All procedures were performed under ultrasound guidance with 4-h post-procedure observation. RESULTS: All 102 biopsies yielded 100% diagnostic success rate with cirrhosis in 85.2% and HCC in 73.5% of patients. Most patients (75.8%) had at least one contraindication for standard biopsy. We observed one mortality in a high-risk Jehovah's Witness patient and one minor complication (hemoglobin drop) managed conservatively. Among 52 patients with follow-up imaging (mean 149 days), one case of suspected intrahepatic tract seeding occurred with no extrahepatic seeding. CONCLUSION: This refined electrocauterization technique provides a safe, effective approach for obtaining diagnostic tissue in high-risk HCC patients with contraindications to standard percutaneous biopsy, offering advantages over conventional tract embolization methods through precise thermal effect localization.