Ultrasonography(USG) guided tissue acquisition has been the modality of choice for diagnosis of focal liver lesions. EUS- TA has now become the mainstay for tissue diagnosis of various intraabdominal mass lesions. EUS guided liver biopsy is also slowly gaining acceptance. But,the safety and efficacy of EUS TA for focal liver lesion is largely unknown. In this study we looked as safety and efficacy of this modality and  also compared the diagnostic accuracy of EUS FNAC and EUS FNB.

In this prospective observational study, we included patients with focal liver lesions who underwent EUS – TA. Size of the lesion and number of passes taken were recorded. EUS guided FNAC followed by EUS guided FNB was done back -to- back during the same endoscopic session. The safety,sample adeqauacy,technical success and diagnostic yield of both FNA and FNB specimens was  calculated based on the final diagnosis and compared.

Of the 40 patients included,42.5 % of patients were females with a mean age of 57.5 ± 12.84 years.9 adenocarcinoma (22.5%),4 hepatocellular carcinoma(10%)4 poorly differentiated carcinoma(10%) 4 regenerating  nodule(10%), 3 liver abscess(7.5%),2 small cell carcinoma(5%),3 squamous cell carcinoma(7.5%),3 non hodgkins lymphoma(7.5%),2 inflammatory granuloma(5%),2 high grade carcinoma(5%),1 adenosquamous carcinoma(2.5%),1 cholangiocarcinoma(2.5%),1 NET was diagnosed(2.5%).3 samples in EUS-FNA group and 1 sample in EUS-FNB was reported inconclusive. It was possible to obtain tissue from lesions in all patients,technical success 100%. Number of passes were significantly more in the EUS FNA group compared to EUS FNB. The diagnostic yield of EUS-FNB was 97.5% as compared to 92.5%. Although diagnostic yield of EUS-FNB was higher than that of EUS-FNB, the difference was not statistically significant.

EUS TA is safe and has a high diagnostic yield in focal liver lesions. In resource constraint settings, either EUS FNA or EUS FNB alone may be sufficient for diagnosis, with EUS FNB being done judiciously when maintained tissue architecture is required.