Objective To explore the effect of different needle track management on Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on liver cancer after liver biopsy.

Methods A retrospective analysis was conducted on the clinical data of 21 patients with liver cancer who underwent Technetium-99m-macroaggregated albumin (^99mTc-MAA) evaluation and ⁹⁰Y-SIRT after liver biopsy from June 2023 to December 2024. The methods of needle track management, hepatic arteriovenous shunting, and lung shunt fraction (LSF) were recorded. The occurrence of hepatic arteriovenous fistula (HAVF), as well as the corresponding countermeasures were analyzed.

Results Among the 21 liver cancer patients, 7 cases (medical glue group) underwent embolization of the needle tract with medical glue (N-butyl 2-cyanoacrylate NBCA) immediately after biopsy, and no significant HAVF was observed during the ^99mTc-MAA tests; 14 cases (non-medical glue group) were treated with delayed needle extraction or gelatin sponge particle blocking after biopsy, among which 7 cases developed significant HAVF, and the fistulas were treated with NBCA. The LSF of the medical glue group was significantly lower than that of the non-medical glue group (7.06±2.33 % vs 12.43±7.73 %, P＝0.037). All 21 patients successfully completed ⁹⁰Y-SIRT.

Conclusions Liver biopsy may affect ⁹⁰Y-SIRT by causing iatrogenic HAVF. Immediate NBCA-embolization of the needle tract after biopsy or timely NBCA-embolization of fistulas during ^99mTc-MAA tests may reduce the impact.