The Value of Liver Biopsy and Histology in Liver Disease Diagnosis and Patient Care-a Pragmatic Prospective Clinical Practice Study.
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| Názov: | The Value of Liver Biopsy and Histology in Liver Disease Diagnosis and Patient Care-a Pragmatic Prospective Clinical Practice Study. |
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| Autori: | Khalifa A; Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC., Rockey DC |
| Zdroj: | Journal of clinical gastroenterology [J Clin Gastroenterol] 2024 Oct 01; Vol. 58 (9), pp. 912-916. Date of Electronic Publication: 2024 Oct 01. |
| Spôsob vydávania: | Journal Article |
| Jazyk: | English |
| Informácie o časopise: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 7910017 Publication Model: Electronic Cited Medium: Internet ISSN: 1539-2031 (Electronic) Linking ISSN: 01920790 NLM ISO Abbreviation: J Clin Gastroenterol Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2015- > : Philadelphia, PA : Wolters Kluwer Health, Inc. Original Publication: New York, Masson. |
| Výrazy zo slovníka MeSH: | Liver Diseases*/pathology , Liver Diseases*/diagnosis , Liver*/pathology, Humans ; Prospective Studies ; Biopsy/methods ; Male ; Female ; Middle Aged ; Adult ; Aged ; Hepatitis, Autoimmune/pathology ; Hepatitis, Autoimmune/diagnosis ; Surveys and Questionnaires ; Non-alcoholic Fatty Liver Disease/pathology ; Non-alcoholic Fatty Liver Disease/diagnosis ; Predictive Value of Tests ; Liver Diseases, Alcoholic/pathology ; Liver Diseases, Alcoholic/diagnosis |
| Abstrakt: | Goals: We aimed to examine the correlation of pre-biopsy clinical diagnosis with hepatic histopathology. Background: Liver biopsy provides histologic information and informs physicians about the underlying clinical disease. We hypothesized that expert physicians' pre-biopsy clinical diagnoses may obviate the need for histopathological diagnosis. Study Methods: Patients undergoing liver biopsy to investigate a liver diagnosis were prospectively identified. In the 80 patients included, an anonymous validated questionnaire inquiring about the most likely clinical diagnosis and liver disease stage was completed prospectively by hepatologists before biopsy performance. Results: The most common pre-biopsy diagnoses were alcoholic liver disease (19 diagnoses), followed by non-alcoholic steatohepatitis and autoimmune hepatitis (18 each). Overall, the predicted histologic diagnosis was the same as the histologic diagnosis in 51/80 patients (64%), and thus a new liver disease diagnosis was made in 36% of patients. The diagnosis with the greatest pre-biopsy and post-biopsy diagnosis discrepancy was autoimmune hepatitis, with the correct diagnosis being predicted in 6/18 (33%) of patients (other diagnoses included the following: non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (4), alcoholic liver disease (3), drug-induced liver injury (3), others (2)). For fibrosis staging, when grouped as no fibrosis (F0), fibrosis (F1-F3), or cirrhosis (F4), the fibrosis stage was correctly predicted in 68% of patients (54/80). Notably, 7 patients (9%) who were initially thought to have no or early-stage fibrosis had F4 fibrosis, and 6/80 (8%) patients who were considered to have a liver disease diagnosis before their biopsy had normal histology. Conclusions: Although hepatology experts often predict the correct underlying liver disease diagnosis, histopathological diagnoses different from expected are common. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
| References: | Rockey DC, Caldwell SH, Goodman ZD, et al. Liver biopsy. Hepatology. 2009;49:1017–1044. Khalifa A, Rockey DC. The utility of liver biopsy in 2020. Curr Opin Gastroenterol. 2020;36:184–191. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500. Spycher C, Zimmermann A, Reichen J. The diagnostic value of liver biopsy. BMC Gastroenterol. 2001;1:12. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004;328:1312–1315. Gasmi B, Kleiner DE. Liver histology: diagnostic and prognostic features. Clin Liver Dis. 2020;24:61–74. Kleiner DE, Makhlouf HR. Histology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults and children. Clin Liver Dis. 2016;20:293–312. Boyd A, Cain O, Chauhan A, et al. Medical liver biopsy: Background, indications, procedure and histopathology. Frontline Gastroenterol. 2020;11:40. Tiniakos DG, Brain JG, Bury YA. Role of histopathology in autoimmune hepatitis. Dig Dis. 2015;33(suppl 2):53–64. Aydinli M, Bayraktar Y. Budd-Chiari syndrome: etiology, pathogenesis and diagnosis. World J Gastroenterol. 2007;13:2693–2696. Neil DA, Hubscher SG. Are parenchymal changes in early post-transplant biopsies related to preservation-reperfusion injury or rejection? Transplantation. 2001;71:1566–1572. Demetris A, Adams D, Bellamy C, et al. Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology. 2000;31:792–799. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet (London, England). 2008;371:838–851. Ducazu O, Degroote H, Geerts A, et al. Diagnostic and prognostic scoring systems for autoimmune hepatitis: a review. Acta Gastroenterol Belg. 2021;84:487–495. Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–938. Takyar V, Etzion O, Heller T, et al. Complications of percutaneous liver biopsy with Klatskin needles: a 36-year single-centre experience. Aliment Pharmacol Ther. 2017;45:744–753. |
| Entry Date(s): | Date Created: 20231204 Date Completed: 20240907 Latest Revision: 20250613 |
| Update Code: | 20250614 |
| DOI: | 10.1097/MCG.0000000000001950 |
| PMID: | 38047588 |
| Databáza: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Goals: We aimed to examine the correlation of pre-biopsy clinical diagnosis with hepatic histopathology.<br />Background: Liver biopsy provides histologic information and informs physicians about the underlying clinical disease. We hypothesized that expert physicians' pre-biopsy clinical diagnoses may obviate the need for histopathological diagnosis.<br />Study Methods: Patients undergoing liver biopsy to investigate a liver diagnosis were prospectively identified. In the 80 patients included, an anonymous validated questionnaire inquiring about the most likely clinical diagnosis and liver disease stage was completed prospectively by hepatologists before biopsy performance.<br />Results: The most common pre-biopsy diagnoses were alcoholic liver disease (19 diagnoses), followed by non-alcoholic steatohepatitis and autoimmune hepatitis (18 each). Overall, the predicted histologic diagnosis was the same as the histologic diagnosis in 51/80 patients (64%), and thus a new liver disease diagnosis was made in 36% of patients. The diagnosis with the greatest pre-biopsy and post-biopsy diagnosis discrepancy was autoimmune hepatitis, with the correct diagnosis being predicted in 6/18 (33%) of patients (other diagnoses included the following: non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (4), alcoholic liver disease (3), drug-induced liver injury (3), others (2)). For fibrosis staging, when grouped as no fibrosis (F0), fibrosis (F1-F3), or cirrhosis (F4), the fibrosis stage was correctly predicted in 68% of patients (54/80). Notably, 7 patients (9%) who were initially thought to have no or early-stage fibrosis had F4 fibrosis, and 6/80 (8%) patients who were considered to have a liver disease diagnosis before their biopsy had normal histology.<br />Conclusions: Although hepatology experts often predict the correct underlying liver disease diagnosis, histopathological diagnoses different from expected are common.<br /> (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
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| ISSN: | 1539-2031 |
| DOI: | 10.1097/MCG.0000000000001950 |