Comparison of outcomes of an 18-gauge vs 16-gauge ultrasound-guided percutaneous renal biopsy: a systematic review and meta-analysis

The needle size used in ultrasound-guided percutaneous renal biopsy significantly influences the efficacy and safety of the procedure. The aim of this study is to perform a comparative analysis of 16-gauge and 18-gauge needles for ultrasound-guided percutaneous renal biopsy. This systematic review and meta-analysis included randomized controlled trials and observational studies that compared the outcomes of using 18-gauge and 16-gauge needles for ultrasound-guided percutaneous renal biopsy. The efficacy parameters included a mean number of glomeruli obtained and the number of passes, while the safety parameters focused on the rate of complications. We searched multiple databases, assessed the risk of bias, and conducted statistical analyses using appropriate models. Fifteen studies were included. Compared to the 18-gauge needle, the use of 16-gauge needle for the biopsy was associated with the significantly higher mean number of glomeruli obtained (pooled SMD 0.61, 95%CI: 0.32 to 0.89; <i>p</i> &lt; 0.001) and fewer required passes (pooled SMD −0.57, 95%CI: −0.97 to −0.18; <i>p</i> = 0.004). No significant difference was observed in the individual safety parameters, including pain, hematuria, need for blood transfusion, major, and minor complications. However, the use of 16-gauge needle was associated with higher odds of total complications (pooled OR 1.57, 95%CI: 1.16 to 2.13; <i>p</i> = 0.004). While the 16-gauge needle for ultrasound-guided percutaneous renal biopsy offers improved efficacy in terms of a higher mean number of glomeruli and fewer required passes, it is associated with higher total complications. A judicious needle size selection that would consider patient-specific factors and risk-benefit ratio, is crucial for optimizing patient outcomes.

超声引导下经皮肾活检所使用的穿刺针规格，会对该操作的有效性与安全性产生显著影响。本研究旨在针对超声引导下经皮肾活检中使用的16号（16-gauge）与18号（18-gauge）穿刺针开展对比分析。本项系统评价与荟萃分析纳入了对比超声引导下经皮肾活检中使用18号与16号穿刺针结局的随机对照试验及观察性研究。有效性指标包括获取肾小球的平均数量与穿刺次数，安全性指标则聚焦于并发症发生率。研究团队检索了多个数据库，评估了偏倚风险，并采用合适的模型开展了统计学分析。最终共纳入15项研究。与18号穿刺针相比，肾活检中使用16号穿刺针可显著提升获取肾小球的平均数量（合并标准化均数差（Standardized Mean Difference，SMD）=0.61，95%置信区间（Confidence Interval，CI）：0.32~0.89；p＜0.001），同时减少所需穿刺次数（合并标准化均数差（Standardized Mean Difference，SMD）=-0.57，95%置信区间（Confidence Interval，CI）：-0.97~-0.18；p=0.004）。在各项单项安全性指标（包括疼痛、血尿、输血需求、严重并发症与轻微并发症）方面未观察到显著差异。然而，使用16号穿刺针与更高的总并发症发生率相关（合并优势比（Odds Ratio，OR）=1.57，95%置信区间（Confidence Interval，CI）：1.16~2.13；p=0.004）。尽管超声引导下经皮肾活检使用16号穿刺针可在获取更多肾小球平均数量与减少穿刺次数方面提升操作有效性，但同时也伴随着更高的总并发症风险。综合考虑患者个体特征与风险获益比，审慎选择穿刺针规格，对于优化患者结局至关重要。