Histopathologic Variability Between the Right and Left Lobes of the Liver in Morbidly Obese Patients Undergoing Roux-en-Y Bypass

Larson, Steven P.; Bowers, Steven P.; Palekar, Nicole; Ward, John A.; Pulcini, Joseph P.; Harrison, Stephen A.

doi:10.1016/j.cgh.2007.06.005

Cited by 100 publications

(89 citation statements)

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“…In addition, there might be differences between right and left lobes of the liver, as the left lobe is relatively smaller, is covered by more capsule per unit area, and the subcapsular portal tracts can be deceptively more fibrous than those of deeper parenchyma. Differences in histopathological findings have been demonstrated in studies of bariatric patients biopsied concurrently from the right and left lobes [25] ; these differences were abrogated somewhat by the use of a large bore needle in another study [24] . Adequate sample length has also been noted as a correlative factor with histological evaluation in NAFLD [26] , with biopsies ≥ 1.5 cm long having a higher yield of definitive nonalcoholic steatohepatitis (NASH) diagnosis compared to those measuring < 1 cm in length (29% vs 56%) [26] .…”

Section: Introductionmentioning

confidence: 92%

“…Many can be overcome by the realization that even an adequate biopsy represents only 1/50 000-1/65 000 of this large organ. Therefore, high quality biopsy techniques, such as utilization of appropriately sized needles [24] , careful choice of sampled area, and appropriate tissue preparation and interpretation are all important considerations for liver biopsy. Pathologists recognize that wedge biopsies are inferior to appropriately-sized and placed needle core biopsies for evaluation of a diffuse parenchymal disease.…”

Section: Introductionmentioning

confidence: 99%

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Histopathology of Non-Alcoholic Fatty Liver Disease

Brunt

2009

Clinics in Liver Disease

115

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Histological analysis of liver biopsies remains a standard against which other methods of assessment for the presence and amount of hepatic injury due to nonalcoholic fatty liver disease (NAFLD) are measured. Histological evaluation remains the sole method of distinguishing steatosis from advanced forms of NAFLD, i.e. nonalcoholic steatohepatitis (NASH) and fibrosis. Included in the lesions of NAFLD are steatosis, lobular and portal inflammation, hepatocyte injury in the forms of ballooning and apoptosis, and fibrosis. However, patterns of these lesions are as distinguishing as the lesions themselves. Liver injury in adults and children due to NAFLD may have different histological patterns. In this review, the rationale for liver biopsy, as well as the histopathological lesions, the microscopically observable patterns of injury, and the differential diagnoses of NAFLD and NASH are discussed.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Histopathology of Non-Alcoholic Fatty Liver Disease

Brunt

2009

Clinics in Liver Disease

115

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“…Nevertheless, regional differences in HFF up to 12% obtained in the present study are not controversial to the biopsy results [13,25,26] .…”

Section: Discussionmentioning

confidence: 75%

“…Visual histological assessment of "within liver" HFF variability showed excellent agreement for steatosis (κ=0.91 [25] and κ=0.88 [26] ) between the right and left lobes of the liver according to steatosis grading scale 0-3 in morbidly obese patients.…”

Section: Discussionmentioning

confidence: 92%

Regional differences in hepatic fat fractions in over- weight children and adolescents observed by 3T 1H-MR spectroscopy

Chabanova

Bille²,

Thisted³

et al. 2012

JBGC

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Background: Proton MR Spectroscopy ( 1 H MRS) can be used to measure hepatic fat fractions (HFF) in liver cells for assessment of non-alcoholic fatty liver disease (NAFLD). The measurement is typically performed in a single volume. For correct diagnosis it is important to know variability of HFF within liver. The purpose of this study was to investigate regional differences in HFF in a large group of overweight and obese children and adolescents using 1H MRS at 3T. Methods:The study included 175 consecutive children and adolescents from 7 to 18 years old with a body mass index above the 97th percentile according to age and gender.1 H MRS was performed at 3.0T using a point resolved spectroscopy sequence in two 11mmx11mmx11mm volumes positioned in different parts of the right liver lobe.Results: Up to 12% difference in HFF between the two volumes was observed: the regional differences in HFF are below 1% for patients with HFF under 3%; patients with HFF between 3% and 20% have regional differences in HFF up to 5%; patients with HFF over 20% have regional differences in HFF up to 12%.Conclusions: 1H MRS diagnosis and severity assessment of NAFLD in overweight and obese children and adolescents should take up to 12% regional differences in hepatic fat fractions into account.

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“…Non-alcoholic fatty liver disease has become the most common chronic liver disease in the Western world, with between 10% and 20% of the patients progressing to non-alcoholic steatohepatitis, which may in turn lead to liver cirrhosis [44][45][46]. In current practice, parenchymal dysfunction is encountered with increasing frequency in non-cirrhotic patients, and both chemotherapy-induced liver injury and metabolic syndrome-associated hepatic disease have been shown to be unevenly distributed in the liver [47][48][49].…”

Section: Discussionmentioning

confidence: 99%