How to improve the quality of the tissue sample obtained by percutaneous liver biopsy

• Authors: Ioan Sporea , Alina Popescu , Roxana Şirli
• Languages of publication: EN

Abstracts

EN

The evaluation of liver lesions in patients with chronic hepatopathy is mandatory for assessing prognosis and sometimes for making treatment decisions. The liver biopsy (LB) is still considered the gold standard for the evaluation of chronic hepatopathy, despite the fact that noninvasive methods (serologic markers and transient elastography or real-time elastography) are being used more often. The quality of the hepatic tissue sample obtained at biopsy is important for the correct diagnosis. Usually, a liver specimen is considered to be adequate for pathological examination if it is no less than 20 mm and preferably more than 25 mm and if it includes 8 to 11 portal tracts. To improve the quality of the tissue sample obtained by percutaneous LB, we believe it is optimal for the operator to use the Menghini needle technique with two intrahepatic passages (specimens up to 4 cm in length can be obtained), to use echo guidance or ultrasonographic assistance, to have extensive personal experience (defined as having performed between 50 and 100 biopsies), and to assess the length of the tissue sample immediately after the LB, and, in the event the specimen is inadequate in length, to rapidly perform another passage.

Keywords

EN

Liver biopsy; Quality of the tissue sample; Biopsy needle

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2011
• Volume: 6
• Issue: 1
• Pages: 103-106

Dates

published

1 - 2 - 2011

online

16 - 12 - 2010

Contributors

author

Ioan Sporea

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300842, Timişoara, Romania

author

Alina Popescu

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300842, Timişoara, Romania

author

Roxana Şirli

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300842, Timişoara, Romania

References

• [1] Friedman LS: Controversies in liver biopsy: who, where, when, how and why? Current Gastroenterology Reports 2004;6:30–36 http://dx.doi.org/10.1007/s11894-004-0023-4[Crossref]
• [2] The British Society of Gastroenterology Guidelines on the use of liver biopsy in clinical practice. Gut 1999; 45(Suppl.4): 1–11
• [3] Guido M, Rugge M: Liver biopsy sampling in chronic viral hepatitis. Semin Liver Dis Feb 2004; 24(1):89–97 http://dx.doi.org/10.1055/s-2004-823103[Crossref]
• [4] Colloredo G, Guido M, Sonzogni A, Leandro G: Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003;39:239–244 http://dx.doi.org/10.1016/S0168-8278(03)00191-0[Crossref]
• [5] Abdi W, Milan JC, Mezey E: Sampling variability on percutaneous liver biopsy. Arch Intern Med 1979;139:667–669 http://dx.doi.org/10.1001/archinte.139.6.667[Crossref]
• [6] Bedossa P, Dargere D, Paradis V: Sampling variability of liver fibrosis in chronic hepatitis. Hepatology 2003;38:1449–1457 [Crossref][PubMed]
• [7] Beaugrand M: FibroScan instructions for use. Journées Francophones de Pathologie Digestive, Gastroenterol. Clin. Biol. 2006;30:513–514
• [8] de Man RA, van Buuren HR, Hop WC: A randomised study on the efficacy and safety of an automated Tru-Cut needle for percutaneous liver biopsy. Neth J Med 2004;62:441–445
• [9] Sporea I, Popescu A, Focşa M, Becheanu G, Şirli R, Cornianu M et al: The quality of the liver biopsy fragment obtained depending on the type of the biopsy needle used. J Gastrointestin Liver Dis 2009; 18(suppl 1): 88–89
• [10] Piccinino F, Sagnelli E, Pasquale G, Giusti G: Complications following percutaneous liver biopsy: a multiple retrospective study on 68276 biopsies. J Hepatol 1986;2:165–173 http://dx.doi.org/10.1016/S0168-8278(86)80075-7[Crossref]
• [11] Lindor KD, Bru C, Jorgensen RA, Rakela J, Bordas JM, Gross JB et al: The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology 1996;23:1079–1083 http://dx.doi.org/10.1002/hep.510230522[Crossref]
• [12] Younossi ZM, Teran JC, Ganiats TG, Carey WD: Ultrasound-guided liver biopsy for parenchymal liver diseases: an economical analysis. Dig Dis Sci 1998;43:46–50 http://dx.doi.org/10.1023/A:1018815802500[Crossref]
• [13] Pasha T, Gabriel S, Therneau T, Dickson ER, Lindor KD: Cost-effectiveness of ultrasound-guided liver biopsy. Hepatology 1998;27:1220–1226 http://dx.doi.org/10.1002/hep.510270506[Crossref]
• [14] Jensen DM: Liver biopsy in the management of hepatitis C: not always required. AGA Perspectives 2005;4:5–12
• [15] Cadranel JF, Rufat P, Degos F: Practices of liver biopsy in France: results of a prospective nationwide survey. Hepatology 2000; 32: 477–481 http://dx.doi.org/10.1053/jhep.2000.16602[Crossref]
• [16] Riley TR: How often does ultrasound making change the liver biopsy site. Am J Gastroenterol 1999; 94: 3320–3322 http://dx.doi.org/10.1111/j.1572-0241.1999.01545.x[Crossref]
• [17] Sporea I, Sirli R, Popescu A, Cornianu M, Manciu C, Focşa M: The quality of the fragment obtained by liver biopsy for staging chronic hepatitis. J Gastrointestin Liver Dis 2007; 16(3),263–266
• [18] Sporea I, Popescu Alina, Sirli Roxana: Why, who and how should perform liver biopsy in chronic liver diseases. World J Gastroenterol 2008; 14(21):3396–3402 http://dx.doi.org/10.3748/wjg.14.3396[Crossref][WoS]
• [19] Poynard T, Halfon P, Castera L, Charlotte F, Le Bail B, Munteanu M et al; FibroPaca Group.: Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy lengh and fragmentation. Aliment Pharmacol Ther 2007;25:733–739 http://dx.doi.org/10.1111/j.1365-2036.2007.03252.x[Crossref][WoS]
• [20] Poynard T, Munteanu M, Imbert-Bismut F, Charlotte F, Thabut D, Le Calvez S et al: Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clin Chem 2004;50:1344–1355 http://dx.doi.org/10.1373/clinchem.2004.032227[Crossref]
• [21] Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato MF, Ronchi G et al: Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic evaluation of liver fibrosis in patients with chronic. Gut 2007; 56; 968–973 http://dx.doi.org/10.1136/gut.2006.111302[Crossref][WoS]

Identifiers

DOI

10.2478/s11536-010-0068-8