Sampling Variability on Percutaneous Liver Biopsy in Patients with Chronic Hepatitis C Virus Infection

Siddique, Iqbal; El-Naga, Hisham Abu; Madda, John Patrick; Memon, Anjum; Hasan, Fuad

doi:10.1080/00365520310000825

Cited by 152 publications

(112 citation statements)

References 28 publications

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“…However, liver biopsy as an invasive procedure has a small risk of complications, such as pneumothorax, pain, hemorrhage, or puncture of other viscera (3,5). In addition, sampling error causes only 65% correction in liver biopsy specimens (6,7). Liver biopsy cannot be performed universally in all patients with impaired hemostasis of any cause (8).…”

Section: Hepatitis B Virus (Hbv) and Hepatitis C Virus (Hcv) The Majmentioning

confidence: 99%

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

et al. 2008

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Section: Hepatitis B Virus (Hbv) and Hepatitis C Virus (Hcv) The Majmentioning

confidence: 99%

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

et al. 2008

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“…Less than that and there are likely to be significant inaccuracies in assessment. [17][18][19][20][21] An additional sampling problem concerns small biopsy specimens obtained from the subcapsular region. For perhaps approximately 0.5 cm below the capsule, increased stroma, including septum formation and perhaps even nodularity, may be within the spectrum of normal.…”

Section: Caveats Regarding Specimen Adequacymentioning

confidence: 99%

Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach

2007

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The terminology for assessment of chronic viral hepatitis in liver biopsy specimens has become confusing with the proliferation of grading and staging schemes that have paralleled the rise of the hepatitis C epidemic and the importance of mixed viral infections. This review represents a personal approach to the interpretation of these biopsy specimens, aiming at clarifying and simplifying the important points for the general pathologist confronted by these diagnostic dilemmas. The most commonly used schemes-Ishak modification of the Knodell 'hepatic activity index', Scheuer, Metavir, Batts-Ludwig classifications-are presented with evaluation of their pros and cons. Which scheme is selected is less important than the consistent use of a single scheme and the clear naming of that scheme in pathology reports. The importance and clinical implications of identifying severe necroinflammatory activity in the form of 'confluent necrosis' is discussed. Pathologists must also be clear about assessing concomitant diseases, in particular, alcoholic or non-alcoholic fatty liver disease, and be aware that grading/staging schemes for chronic hepatitis do not apply to mixed disease conditions. Other important features to be evaluated in all chronic hepatitis biopsy specimens include iron (which may represent hereditary hemochromatosis or secondary uptake) and neoplasia-associated changes, namely large cell change and small cell change; these findings and their clinical import are updated and reviewed. Sample approaches to composing useful diagnostic reports are also presented. Modern Pathology (2007) 20, S3-S14. doi:10.1038/modpathol.3800693Keywords: grading; staging; chronic hepatitis; viral hepatitis; liver biopsy Once upon a time, the assessment of liver biopsy specimens from patients with chronic viral hepatitis was very simple. There were three categories created for us by the Gnomes (not fairytale, mythical, woodland folk, but 'an International Working Group' of liver pathologists): chronic persistent, active, and lobular hepatitis (CPH, CAH, and CLH, respectively).1 In addition, one would describe the scarring and the progression toward cirrhosis. These categories were sufficient because there were only three likely diseases to be dealt with: autoimmune hepatitis, hepatitis B, and non-A-non-B hepatitis. For the first two, these categories of histopathology were reasonably prognostic. Also, only autoimmune hepatitis had a treatment, which was immune suppression. As for non-A, non-B hepatitis, welly there wasn't much to be said for that beyond describing the histologic changes, knowing that CPH, CAH, and CLH were not predictive in those cases.Then things changed. Hepatitis C was discovered and the true extent of the epidemic was made clear. Antiviral treatments were developed that required assessments in clinical trials and detailed comparison between pre-and post-treatment biopsies. Continuing intravenous drug use in urban centers made mixed viral infections more common. Most liver biopsies were not performed for autoimmu...

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“…However, liver biopsy is invasive and painful [7,8], and the accuracy of liver biopsy has also been questioned because of sampling errors and intra-and inter-observer variability [9][10][11]. Thus, noninvasive methods of measuring the degree of hepatic fibrosis have been developed, such as surrogate serum fibrosis markers [12][13][14][15], liver stiffness measurement with using Fibroscan (Echosense, Paris, France) [16][17][18], various imaging methods [19] and, more recently, glycomics [20].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Surrogate Serum Markers and Transient Elastography (Fibroscan) for Assessing Cirrhosis in Patients with Chronic Viral Hepatitis

Lee

Cheong

et al. 2010

Dig Dis Sci

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Background Progressive hepatic fibrosis with development of cirrhosis is a feature of almost all chronic liver diseases. Aims We assessed the performance of Fibroscan in patients with chronic viral hepatitis, and in comparison with and combined with several surrogate serum markers for predicting cirrhosis. Methods In this prospective multicenter cohort study, a novel panel of serum markers was constructed and serum levels of surrogate markers of liver fibrosis and Fibroscan were compared with the stage of fibrosis in the liver biopsy specimens obtained from 121 subjects with chronic viral hepatitis. Another 159 patients were enrolled to validate the diagnostic accuracy of this novel panel.Results Multivariate analysis identified platelet count and procollagen III N-terminal peptide (PIIINP) as independent predictors of liver cirrhosis. The PP score (combining of platelet count and PIIINP) showed significantly better diagnostic accuracy (areas under the receiver operating characteristic curves, AUROC: 0.885) than that of previously reported serologic tests, including APRI, Fibroscan and PP score, and previously reported serologic tests in the estimation group. Conclusions Fibroscan and surrogate serum markers had similar accuracy for predicting cirrhosis, and combining Fibroscan and serum markers did not improve the accuracy.

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Sampling Variability on Percutaneous Liver Biopsy in Patients with Chronic Hepatitis C Virus Infection

Abstract: Sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection and should be taken into consideration when decisions regarding prognosis and therapy are made based on biopsy, and when defining histological response to antiviral regimens.

Cited by 152 publications

References 28 publications

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach

Comparison of Surrogate Serum Markers and Transient Elastography (Fibroscan) for Assessing Cirrhosis in Patients with Chronic Viral Hepatitis

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