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 24 May 2018

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News

Liver biopsy sample variability in nonalcoholic fatty liver disease

Histologic lesions of steatohepatitis are unevenly distributed throughout the liver parenchyma, and sampling error of liver biopsy can result in substantial misdiagnosis and staging inaccuracies, finds this month's Gastroenterology.

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In nonalcoholic fatty liver disease, the distinction between steatosis and steatohepatitis and the assessment of the severity of the disease rely on liver histology alone.

In nonalcoholic fatty liver disease, the distinction between steatosis and steatohepatitis and the assessment of the severity of the disease rely on liver histology alone.

Dr Vlad Ratziu and colleagues from France assessed the sampling error of liver biopsy and its impact on the diagnosis and staging of steatohepatitis.

The researchers included 51 patients with nonalcoholic fatty liver disease who underwent percutaneous liver biopsy with 2 samples collected.

Discordance rate for the presence of hepatocyte ballooning was 18%
Gastroenterology

The investigators assessed the agreement between paired biopsy specimens by the percentage of discordant results and by the κ reliability test.

The investigative team found that no features displayed high agreement.

The team noted substantial agreement only for steatosis grade and moderate agreement for hepatocyte ballooning and perisinusoidal fibrosis.

The research team observed fair agreement for Mallory bodies, acidophilic bodies whilst lobular inflammation displayed only slight agreement.

Overall, the researchers determined that discordance rate for the presence of hepatocyte ballooning was 18%.

The team reported that ballooning would have been missed in 24% of patients if only 1 biopsy been performed.

The negative predictive value of a single biopsy for the diagnosis of steatohepatitis was at best 0.74.

The researchers noted that discordance of 1 stage or more was 41%.

In addition the team observed that 6 of 17 patients with bridging fibrosis on 1 sample had only mild or no fibrosis on the other.

The researchers suggested that therefore patients with bridging fibrosis could have been under staged with only 1 biopsy.

Intraobserver variability was systematically lower than sampling variability and therefore could not account for most of the sampling error.

Dr Ratziu's team concluded, “Histologic lesions of steatohepatitis are unevenly distributed throughout the liver parenchyma.”

“Therefore, sampling error of liver biopsy can result in substantial misdiagnosis and staging inaccuracies.”

Gastroenterol 2005: 128(7): 1898
10 June 2005

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