P0520 : Acceptability, reliability and applicability of liver biopsy and non-invasive methods for assessment of hepatic fibrosis and cirrhosis among hepatologists; a web based survey
Mohamed AlboraieMarwa KhairyA. ElsharkawyNoha AsemMohamed El‐KassasFathy ElghamryF. HassanGamal Esmat
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Hepatic fibrosis
Objective To discuss the quantitative assessment of hepatic fibrosis and cirrhosis of rats induced by CCl_4 using ultrasonic integrated backscatter (IBS) and compare with pathological features. Methods Liver's IBS parameters of normal rats and those of injected CCl_4 were measured by AII and AII%. All data were divided into three groups according to the pathologic standard: control group, hepatic fibrosis group and cirrhosis group. Results AII and AII% of case group were higher than those of control groups (P0.01). AII and AII% of cirrhosis group were higher than those of hepatic fibrosis group (P0.01). Conclusion Ultrasonic IBS can detect hepatic fibrosis early, which is able to quantitatively evaluate hepatic fibrosis and cirrhosis.
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Objective To study the value of ultrasound diagnosing left hepatic lobe cap thickness in hepatic fibrosis and earlier hepatic cirrhosis.Methods 93 patients suspected of hepatic fibrosis and earlier hepatic cirrhosis and admitted to the Digestive Department of the First Affiliated Hospital of China Medical University from September 2010 to April 2011 were selected.The left hepatic lobe cap thickness of the patients was tested by color Doppler ultrasound to determine hepatic fibrosis and hepatic cirrhosis with 0.8 mm being negative and ≥0.8 mm being positive.Needle biopsy and surgery were also performed at the same time to confirm the hepatic fibrosis and hepatic cirrhosis.The sensitivity,specificity and accuracy of color Doppler ultrasound were calculated.Results The sensitivity,specificity and accuracy of color Doppler ultrasound were 90.38%(47 /52),87.80%(36 /41) and 89.25%(83 /93) respectively in testing the left hepatic lobe cap thickness.Conclusion The thickness of left hepatic lobe can be regarded as one of evidence in diagnosing hepatic fibrosis and earlier period hepatic cirrhosis.
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Paul Ehrlich is credited with performing the first percutaneous liver biopsy in 1883 in Germany.1 After Menghini reported a technique for "one-second needle biopsy of the liver" in 1958, the procedure became more widely used. The average duration of the intrahepatic phase of previous liver-biopsy techniques had been 6 to 15 minutes.2 Liver biopsy is usually the most specific test to assess the nature and severity of liver diseases. In addition, it can be useful in monitoring the efficacy of various treatments. There are currently several methods available for obtaining liver tissue: percutaneous biopsy, transjugular biopsy, laparoscopic biopsy, or fine-needle . . .
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Percutaneous core liver biopsy plays an important role in the management of parenchymal liver disease in establishing diagnosis, evaluating prognosis and monitoring the effect of therapy. Despite the first biopsy been carried out over 100 years ago, debate surrounds best practice.
Day case liver biopsy has become increasingly popular and has not been shown to be associated with increased complications.1,2 Under most day case regimens, patients are observed for up to six hours post biopsy but the majority of complications occur within the first hour post procedure and studies have suggested that the observation period may be reduced from the standard 4–6 h.3–5
Our study prospectively evaluated short stay (1 hour observation) liver biopsy over a 3 …
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Hepatic cirrhosis is a common disease that poses a serious threat to public health, and is characterized by chronic,progressive and diffuse hepatic lesions preceded by hepaticfibrosis regardless of the exact etiologies. In recent years,considerable achievements have been made in China in research of the etiopathogenesis, diagnosis and especially the treatment of hepatic fibrosis, resulting in much improved prognosis of hepatic fibrosis and cirrhosis. In this paper, the authors review the current status of research in hepatic fibrosis, cirrhosis and their major complications.
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The liver biopsy has a unique place in the investigation of liver disease because the concepts and classification of liver disease are rooted in morphology. Today, the use of the liver biopsy has extended beyond that of diagnosis, to the assessment of disease progression, response to therapy and transplant rejection. To get the best out of the liver biopsy, it is necessary to appreciate the usefulness and limitations of the biopsy specimen. Aspects to consider include: (1) minimizing sampling errors, and appreciating that the changes in the biopsy may not be representative of the primary pathology, (2) good laboratory quality practices to avoid processing artifacts, which may render a biopsy undiagnosable, (3) the appropriate use of special stains and other laboratory techniques, (4) adoption of a systematic and algorithmic approach in the microscopic examination of the biopsy, and (5) good clinicopathological correlation.
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Liver cirrhosis results from chronic liver injury that leads to necroinflammation and fibrosis. The development of liver cirrhosis is significantly associated with increased morbidity and mortality. Liver biopsy has been considered to be the gold standard for the diagnosis of liver cirrhosis, which is characterized by diffuse fibrosis and the development of regenerating nodules. However, liver biopsy is invasive and has some drawbacks, such as sampling error and intraobserver and interobserver variability in the assessment of fibrosis stages. Recently, various non-invasive tests such as serum markers, radiologic tests, and elastography have been investigated to overcome the limitations of liver biopsy. This review will focus on the use of these non-invasive tests for diagnosing liver cirrhosis.
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An aspiration liver biopsy technique was described and three studies were conducted to evaluate the use of the technique for mineral studies. Site of biopsy exerted a significant effect on Cu levels in liver biopsies in one of the studies, but the magnitude of the range was only 36 ppm. In a study to determine the effect of Mo intake and biopsy site on the liver respiration, xanthine oxidase and Mo values, the site of biopsy did not affect these values significantly, but the Mo content of the liver was affected significantly by the Mo intake. When Cu intake and site of biopsy effect was studied in a third experiment, the site of biopsy did not show a significant effect on the level of Cu or Fe in the biopsy, but the effect of Cu intake on liver Cu level was significant.
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A procedure for taking biopsy samples from the ovine liver by a paracostal route is described. Samples were taken from 120 Merino rams on up to 3 occasions over a 3 month period. At the end of the period, the rams were subjected to 2 further biopsies and were then slaughtered, and the liver was removed and homogenised. Copper contents of all samples were determined. Frequency of biopsy did not affect hepatic copper concentration which was significantly overestimated by the biopsy method by approximately 5%. Variability associated with the biopsy procedure was approximately +/- 30 to 40 mg Cu/kg DM (SD) and was small relative to variability between animals. Experimental designs were preferred in which samples are taken before and after treatments are applied; changes in concentration are then analysed. Such analyses eliminate errors associated with variability between animals and the small bias in the sampling procedure. Liver biopsy did not significantly reduce bodyweight or the rate of gain.
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