Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies

Angelucci, Emanuele; Baronciani, D; Lucarelli, G; Baldassarri, Massimo; Galimberti, M; Giardini, Claudio; Martinelli, F; Polchi, P; Polizzi, Vincenzo; Ripalti, Marta; Muretto, Pietro

doi:10.1111/j.1365-2141.1995.tb08412.x

Cited by 132 publications

(88 citation statements)

References 16 publications

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“…These two parameters are reported in the literature to adequately reflect iron load, 22,24 and in our survey reveal a strong correlation, as defined by the Spearman's test. In fact, calculation of the coefficient of determination (R2) showed that LIC correlated with SF (R2=0.417, p<0.001).…”

Section: Resultssupporting

confidence: 77%

See 1 more Smart Citation

Association of hepcidin promoter c.-582 A>G variant and iron overload in thalassemia major

Andreani¹,

Radio²,

Testi³

et al. 2009

Haematologica

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Section: Resultssupporting

confidence: 77%

“…Only liver samples with a dry weight of at least 1 mg were considered for the present study. 22,24 Mean value of dry weight liver biopsies was 2.34 mg (range: 1.06-4.58 mg). SF levels were determined by standard methods during routine blood testing prior to transplant on all the 97 patients.…”

Section: Clinical Parametersmentioning

confidence: 99%

Association of hepcidin promoter c.-582 A>G variant and iron overload in thalassemia major

Andreani¹,

Radio²,

Testi³

et al. 2009

Haematologica

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“…The second condition is that the liver-biopsy specimen is adequate, 1 mg dry weight; variability increases with smaller samples. No complications were observed with liver biopsy, extending the record of safety of liver biopsy in expert hands [3][4][5]. These results corroborate previous observations from these and other investigators [5][6][7] that support chemical measurement of the iron concentration in a liver-biopsy specimen as the reference standard for measurement of the hepatic iron concentration.…”

supporting

confidence: 86%

Reference method for measurement of the hepatic iron concentration

Brittenham

2015

American J Hematol

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What should be the reference method for measurement of the hepatic iron concentration? In this issue of the American Journal of Hematology, Urru and colleagues [1] present further evidence that, in patients with thalassemia major and transfusional iron overload, chemical measurement of the iron concentration in a desiccated liver-biopsy specimen obtained by percutaneous biopsy is highly reproducible, as judged by measurement in a successive specimen, provided that two conditions are met. The first condition is the absence of cirrhosis, defined in this study as Ishak scores [2] of 5 or 6, because, with cirrhosis, the iron distribution within the liver is no longer uniform. The second condition is that the liver-biopsy specimen is adequate, 1 mg dry weight; variability increases with smaller samples. No complications were observed with liver biopsy, extending the record of safety of liver biopsy in expert hands [3][4][5]. These results corroborate previous observations from these and other investigators [5][6][7] that support chemical measurement of the iron concentration in a liver-biopsy specimen as the reference standard for measurement of the hepatic iron concentration. Still, dissonance in the details must be acknowledged; no standard method for liver biopsy procedure, specimen processing and analysis has been established. The biopsy needle (cutting needle or Menghini needle with saline flushing), exposure to saline, formalin, and fixation solutions, use of iron-free containers, specimen processing (fresh or paraffin-embedded; methods of deparaffinization and of digestion), methods of analysis (colorimetric, atomic absorption spectroscopy, inductively coupled plasma mass spectroscopy), and other factors differ among published studies and potentially influence results [5,6]. Hepatic iron concentrations measured in deparaffinized samples were a mean of 23% greater than those in desiccated tissue from fresh liver specimens [6]. The minimum weight for an adequate liver sample for analysis remains uncertain; evidence has been provided both for thresholds of 0.4 mg dry weight [8,9] and for 1 mg dry weight [1,4,5]. Reports of variability in the hepatic iron concentration in different areas of the liver have generally been restricted to studies of cirrhotic livers [10][11][12]; data are lacking in patients with transfusional iron overload without cirrhosis. Even so, the close relationship observed between the hepatic iron concentration and total body iron stores [4] in transfused patients with thalassemia who were free of cirrhosis suggests that the extent of variability is limited.An alternative view of the reference method for measurement of the hepatic iron concentration is that magnetic resonance imaging (MRI), recommended in a variety of guidelines, has become the de facto technique. Nonetheless, since acceptance of the manuscript by Urru et al.[1] for publication, a painstaking systematic review and meta-analysis of this use of MRI has appeared, [13] concluding that "measurements of liver iron concentration by ...

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“…This analysis was conducted after a large in house liver biopsy experience [10] and evidence coming from another study demonstrating not increasing complication rate when one, two, or three specimens are taken [11]. We have already demonstrated that liver iron concentration is predictive of the entire body iron store in patients with thalassemia [6].…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of liver iron concentration measured on a biopsy sample: A validation study in vivo

et al. 2014

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Determination of liver iron concentration is essential to predict iron related tissue damage and to guide chelation therapy. To assess the reliability of a single biopsy iron concentration determination in representing the whole liver iron concentration, we conducted a prospective study performing two immediately successive liver biopsies from 61 noncirrhotic, iron overloaded thalassemia patients, directing the needle to different direction from the same skin cut. The correlation among sample biopsies was determined by both regression analysis and the Bland-Altman method. The results showed that overall correlation between the two samples was high (Pearson's coefficient of correlation r 5 0.970, P < 0.0001; 95% CI 0.951-0.981; R 2 5 0.941). To evaluate if sample dimension had an impact on the analysis we analyzed separately biopsy couples were both sample gross weight were 1 mg dry weight (n 5 16) from the others [one or both had a specimen gross weight <1 mg dry weight (n 5 45)]. In the first case, correlation coefficient r was equal to 0.998 (P < 0.0001; 95% CI: 0.995-0.999; R 2 5 0.996) while in the latter was 0.960 (P < 0.0001; 95% CI: 0.928-0.977; R 2 5 0.921). In no instance second specimen prediction interval was outside the interval implying different prognostic and therapeutic decision if both liver samples gross weight were 1 mg dry weight. The Bland-Altman plot analysis showed the same trend observed using Pearson's correlation coefficient in the analyzed sample categories. Hepatic iron concentration determined in "good quality" biopsy specimen (i.e. sample gross weight 1 mg dry weight) is a reliable indicator of whole liver iron concentration.

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Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies

Cited by 132 publications

References 16 publications

Association of hepcidin promoter c.-582 A>G variant and iron overload in thalassemia major

Association of hepcidin promoter c.-582 A>G variant and iron overload in thalassemia major

Reference method for measurement of the hepatic iron concentration

Reproducibility of liver iron concentration measured on a biopsy sample: A validation study in vivo

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