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Sweeney JR, Arenas DJ, Fortuna D, Tondon R, Furth EE. Virtual biopsies: Proof of concept for a novel quantitative approach to liver biopsy adequacy and pathology education. Am J Clin Pathol 2024; 161:24-34. [PMID: 37598345 DOI: 10.1093/ajcp/aqad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES To quantitatively measure liver biopsy adequacy requirements and the effect of a teaching intervention that uses a virtual biopsy platform. METHODS A library of virtual liver biopsies was created using digital whole-slide, trichrome-stained tissue sections from liver resection material and QuPath image analysis software. Blinded participants staged fibrosis on the virtual biopsies before and after a teaching intervention. RESULTS This platform both modeled adequacy requirements for cirrhosis diagnosis on biopsy material and measured the effect of a teaching intervention on participant performance. Using this platform, diagnostic accuracy for cirrhosis could be modeled according to the function y = λ(1 ‒ e‒x/γ). The platform demonstrated that the relationship between biopsy size and diagnostic accuracy was statistically significant and that biopsies smaller than 6 mm long and 0.8 mm wide were insufficient to diagnosis cirrhosis. The platform also measured improvement in fibrosis staging accuracy among participants following a teaching intervention. CONCLUSIONS These results provide proof of concept for a virtual biopsy method by which outstanding questions in anatomic pathology can be addressed quantitatively using open source software. Future work is needed to validate these findings in clinical practice.
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Affiliation(s)
- Jacob R Sweeney
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, US
| | - Daniel J Arenas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Danielle Fortuna
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Emma E Furth
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
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Transjugular Liver Biopsy in Patients with Liver Transplantation: Comparison of Quick-Core Biopsy and Forceps Biopsy. Cardiovasc Intervent Radiol 2021; 44:574-579. [PMID: 33398595 DOI: 10.1007/s00270-020-02724-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the safety and efficacy of transjugular liver biopsy (TJLB) using a Quick-Core biopsy needle or a forceps biopsy in patients with liver transplantation (LT) who were suspected of having rejection. MATERIALS AND METHODS From June 2015 to January 2017, 98 TJLBs (60 patients) with the Quick-Core biopsy needle and 95 TJLBs (58 patients) with a forceps biopsy system were attempted in patients with LT suspected of having rejection. Technical success, adequacy for diagnosis, number of biopsy instrument passes, the maximum and mean length of the obtained samples, and the complications were retrospectively analyzed. RESULTS TJLB was technically successful in all patients. Adequate specimens were obtained in 95.9% of the biopsy needle group and 91.6% in the forceps group (p = 0.246). The mean number of biopsies was 4.8 ± 1.8 in the biopsy needle group and 6.2 ± 1.7 in the forceps group. The mean size of the biopsy sample was 11.1 ± 3.0 mm in the biopsy needle group and 2.5 ± 1.2 mm in the forceps group. Only one minor complication (a subcapsular hematoma) occurred in the biopsy needle group. No major complication was observed in any patient. CONCLUSION TJLB using a Quick-Core biopsy needle or forceps can be safely and effectively performed in LT patients. The adequacy of sampling for diagnosis was equivalent between the groups. LEVEL OF EVIDENCE Level 4, case series.
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Stift J, Semmler G, Wöran K, Simbrunner B, Scheiner B, Schwabl P, Paternostro R, Pinter M, Stättermayer AF, Meischl T, Beer A, Trauner M, Mandorfer M, Reiberger T. Comparison of the diagnostic quality of aspiration and core-biopsy needles for transjugular liver biopsy. Dig Liver Dis 2020; 52:1473-1479. [PMID: 32928675 DOI: 10.1016/j.dld.2020.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver biopsy remains essential for the diagnostic work-up of patients with liver disease. AIMS To evaluate aspiration vs. core-biopsy needles for transjugular liver biopsy (TJLB) in patients undergoing hepatic venous pressure gradient (HVPG) measurements. METHODS 84 patients undergoing TJLB between 06/2017 and 12/2018 were prospectively included. Liver biopsy specimens were systematically evaluated for quantitative and qualitative criteria such as number of portal tracts, sample length and fragmentation. RESULTS In direct comparison of paired TJLB specimens (n=35), core-biopsy samples were significantly longer (median 12 vs. 9mm, p=0.012), tended to contain more portal tracts (median 8 vs. 6, p=0.064) and were less fragmented (p<0.001), which resulted in better confidence for liver fibrosis assessment (p=0.035). However, a superior quality in terms of less fragmentation of core-biopsy specimens (p<0.05) was only confirmed in patients with HVPG ≥10mmHg or liver stiffness measurement >40kPa. In contrast, the aspiration needle provided significantly longer samples in patients with HVPG <10mmHg (median 21 vs. 12mm, p=0.007) or with liver stiffness measurement <20kPa (median 21 vs. 11mm, p=0.025). CONCLUSION In patients with HVPG ≥10mmHg, we recommend to performed TJLB using core-biopsy needles, while the aspiration needle provides high quality liver biopsy specimens in patients with HVPG <10mmHg.
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Affiliation(s)
- Judith Stift
- Department of Pathology, Medical University of Vienna, Vienna, Austria.
| | - Georg Semmler
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Katharina Wöran
- Department of Pathology, Medical University of Vienna, Vienna, Austria.
| | - Benedikt Simbrunner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Philipp Schwabl
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Rafael Paternostro
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Albert Friedrich Stättermayer
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Tobias Meischl
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Andrea Beer
- Department of Pathology, Medical University of Vienna, Vienna, Austria.
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Mattias Mandorfer
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
| | - Thomas Reiberger
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
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Abstract
PURPOSE OF REVIEW Over the past decade, imaging modalities and serological tests have emerged as important tools in the evaluation of liver diseases, in many cases supplanting the use of liver biopsy and histological examination. Nonetheless, the accuracy and diagnostic value of these methods may not always be conclusive and the assessment of liver histology often remains the gold standard for diagnostic evaluation. The purpose of this review is to summarize the current role of liver biopsy in contemporary hepatology practice. RECENT FINDINGS Technical factors were found to influence the diagnostic value of liver biopsy and histological examination of the liver, including specimen number and size (preferably ≥3 nonfragmented specimens of >20 mm in length), needle diameter (1.6 mm Menghini), number of passes (mean 2.5), imaging-guidance, and operator experience. Liver biopsy was demonstrated to be diagnostically valuable in the evaluation of persistently abnormal liver tests of unclear cause, with histology pointing to a specific diagnosis in 84% of patients. Although coagulation abnormalities continue to be an important concern when performing liver biopsy, their influence on complication risk remains unclear. Implementation of less stringent preprocedural coagulation thresholds decreased preprocedural transfusions without increasing the bleeding rate. Serious complications associated with percutaneous liver-biopsy (PLB) and transjugular liver-biopsy are similar, but pain appears to be more common with PLB. SUMMARY Histopathological evaluation continues to be fundamentally important in assessing hepatic disease, and liver histology remains the most accurate approach to assess fibrosis and assign prognosis.
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Affiliation(s)
- Ali Khalifa
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Kaufman C, Aryafar H, Minocha J, Kinney T. Transjugular liver biopsy after transjugular intrahepatic portosystemic shunt (TIPS) or direct intrahepatic portocaval shunt (DIPS): Is it feasible, effective, and safe? Diagn Interv Imaging 2018; 99:331-335. [PMID: 29366793 DOI: 10.1016/j.diii.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate our experience with transjugular liver biopsies (TJLB) in patients with previously placed transjugular intrahepatic portosystemic shunt (TIPS) or direct intrahepatic portocaval shunt (DIPS). MATERIAL AND METHODS A single-institution retrospective review was performed looking at all TJLBs in patients with previously placed TIPS or DIPS over the past seven years. There were six men and one woman (mean age 57.9±8.8 [SD] years; range: 47-71 years). Patient demographics, indications, procedural details, laboratory data, complications, and pathology were recorded. Patients with occluded TIPS were excluded from this study. RESULTS Seven TJLBs were performed, five in patients who had a TIPS and two who had a DIPS. Of the patients with TIPS, biopsies were performed from the same hepatic vein as TIPS in three procedures and from a different hepatic vein in two procedures. In DIPS patients, both biopsies were performed from the right hepatic vein. The reasons for the transjugular rather than the percutaneous approach to liver biopsy included ascites, coagulopathy, or need for concurrent TIPS/DIPS evaluation and/or revision. All procedures were technically successful with adequate samples obtained. There were no immediate or delayed complications. CONCLUSION Our results suggest that if needed a TJLB can safely and effectively be performed in patients with previously placed TIPS or DIPS.
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Affiliation(s)
- C Kaufman
- University of Utah, Department of Radiology, 30N 1900 E, Salt Lake City, UT 84132 USA.
| | - H Aryafar
- University of California San Diego, Department of Radiology, 200W Arbor Drive, San Diego, CA 92103 USA
| | - J Minocha
- University of California San Diego, Department of Radiology, 200W Arbor Drive, San Diego, CA 92103 USA
| | - T Kinney
- University of California San Diego, Department of Radiology, 200W Arbor Drive, San Diego, CA 92103 USA
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6
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Kim SJ, Won JH, Kim YB, Wang HJ, Kim BW, Kim H, Kim J. Plugged percutaneous biopsy of the liver in living-donor liver transplantation recipients suspected to have graft rejection. Acta Radiol 2017; 58:771-777. [PMID: 27754919 DOI: 10.1177/0284185116673121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Percutaneous biopsy is a widely-accepted technique for acquiring histologic samples of the liver. When there is concern for bleeding, plugged percutaneous biopsy (PPB) may be performed, which involves embolization of the biopsy tract. Purpose To evaluate the efficacy and safety of PPB of the liver in patients suspected to have graft rejection after living-donor liver transplantation (LDLT). Material and Methods During January 2007 and December 2013, 51 patients who underwent PPB of the liver under the suspicion of post-LDLT graft rejection were retrospectively analyzed. A total of 73 biopsies were performed. Biopsy was performed with a 17-gauge core needle and 18-gauge cutting needle. The needle tract was embolized using gelatin sponge (n = 44) or N-butyl cyanoacrylate (NBCA) (n = 29). The specimens were reviewed to determine their adequacy for histologic diagnosis. We reviewed all medical records after PPB. Results Specimens were successfully acquired in all procedures (100%). They were adequate for diagnosis in 70 cases (95.9%) and inadequate in three (1.3%). Average of 9.8 complete portal tracts was counted per specimen. One minor complication (1.4%) occurred where the patient had transient fever after the procedure. Conclusion PPB is easy and safe to perform in LDLT recipients and provides high diagnostic yield.
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Affiliation(s)
- Sung Jung Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Jung Wang
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bong-Wan Kim
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
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Pattern and profile of chronic liver disease in acute on chronic liver failure. Hepatol Int 2015; 9:366-72. [PMID: 26016461 DOI: 10.1007/s12072-015-9627-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/30/2015] [Indexed: 12/19/2022]
Abstract
The etiology of the chronic liver disease (CLD) in patients with acute on chronic liver failure (ACLF) may vary from region to region. The major cause of underlying CLD is viral (hepatitis B and C) in the East, while it is alcohol related in the West and in some parts of the Indian subcontinent. Autoimmune liver disease and Wilson's disease are the major underlying etiologies in the pediatric age group. The patients with CLD without cirrhosis should be included when defining ACLF. Non-alcoholic fatty liver disease related chronic liver insult in patients with known risk factors for progressive disease should be taken as a chronic liver disease in the setting of ACLF, whereas fatty liver with normal aminotransferases in low risk patients should not. The patients with CLD and previous decompensation should be excluded. Diagnosis of chronic liver disease in the setting of ACLF is made by history, physical examination and previously available or recent laboratory, endoscopic or radiological investigations. A liver biopsy through the transjugular route may help in cases where the presence of underlying CLD or its cause is not clear. The need of liver biopsy in ACLF should, however, be individualized. Standardization of liver biopsy assessment is essential for a uniform approach to the diagnosis and treatment of CLD and acute insult. Tools to measure liver stiffness may aid in identifying patients with advanced fibrosis. Studies are needed to validate the performance of these tests in the setting of ACLF.
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8
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Optimizing needle direction during transjugular liver biopsy provides superior biopsy specimens. Cardiovasc Intervent Radiol 2013; 37:1540-5. [PMID: 24352863 DOI: 10.1007/s00270-013-0819-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/24/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE Transjugular liver biopsy (TJLB) is commonly performed for staging of liver fibrosis and cirrhosis among patients with coagulopathy and/or ascites. We hypothesized that device orientation during needle firing influences hepatic tissue apposition with the specimen notch and specimen quality. METHODS Needle biopsies were performed in ex vivo bovine livers with specimen notch of the biopsy device oriented at cranial, caudal, or lateral directions with respect to the guiding metal cannula. Biopsy specimen length was measured and evaluated for fragmentation using light microscopy. In addition, a consecutive cohort of patients (n = 50) who underwent TJLB with random (n = 22) or caudal (n = 28) needle orientation was retrospectively reviewed. The number of needle passes was documented, and pathology specimen adequacy was graded using an ordinal scale. RESULTS A total of 400 biopsies were performed (100 in each orientation) in ex vivo bovine livers. Longer specimens were obtained with caudal orientation of the needle specimen notch (p < 0.0001, ANOVA and Kruskal-Wallis tests). There was no difference in the degree of fragmentation. In the retrospective clinical study, specimen adequacy was significantly higher among patients in the caudal orientation group (p = 0.0002, Mann-Whitney U test). CONCLUSION Caudal orientation of the needle specimen notch of the biopsy device during TJLB produces superior core biopsy specimens. This simple technical modification may assist in obtaining higher-quality biopsy specimens during TJLB.
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9
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Abstract
Liver biopsy is considered the gold standard for the evaluation of acute and chronic liver disorders. Transjugular liver biopsy (TJLB) was described by Dotter in 1964 and clinically performed for the first time by Hanafee in 1967. TJLB consists of obtaining liver tissue through a rigid cannula introduced into one of the hepatic veins, typically using jugular venous access. The quality of the TJLB specimens has improved so much that the samples obtained by this method are comparable with those obtained with the percutaneous technique. TJLB is indicated for patients with coagulopathy, ascites, peliosis hepatis, morbid obesity, liver transplant, or in patients undergoing a transjugular intrahepatic portosystemic shunt procedure. The technical success rate for a TJLB procedure ranges from 87 to 97%. Sample fragmentation has been reported in 14 to 25% of the TJLB samples. The complication rates are low and range between 1.3% and 6.5%. The purpose of this article is to provide a review of the fundamental aspects of the TJLB procedure, including technique, indications, contraindications, results, and complications.
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Affiliation(s)
- George Behrens
- Section of Interventional Radiology, Department of Radiology and Nuclear Medicine, RUSH University Medical Center, Chicago, Illinois
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10
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Miraglia R, Maruzzelli L, Spada M, Riva S, Luca A, Gridelli B. Transjugular liver biopsy in pediatric patients with left split liver transplantation and severe coagulation impairment. Pediatr Transplant 2012; 16:58-62. [PMID: 22081991 DOI: 10.1111/j.1399-3046.2011.01605.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study is to report our experience in TJLB performed in pediatric patients who underwent partial LT using a left lateral segments graft. Eight consecutive TJLBs were performed in six patients with contraindication to percutaneous biopsy owing to severe coagulation impairment and ascites. All procedures were performed using an 18-gauge automated core needle biopsy. Median age of the patients was 44 months (range, 11-198). Median patients' weight was 13 kg (range, 8-45). Technical success was achieved in all cases without complications. The specimens were adequate for the diagnosis in all cases.
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Affiliation(s)
- Roberto Miraglia
- Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy.
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11
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Miraglia R, Maruzzelli L, Minervini MI, Volpes R, Vizzini G, Gruttadauria S, Caruso S, Luca A, Gridelli B. Transjugular liver biopsy in liver transplant patients using an 18-gauge automated core biopsy needle. Eur J Radiol 2011; 80:e269-72. [DOI: 10.1016/j.ejrad.2010.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 12/01/2010] [Indexed: 12/19/2022]
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Behrens G, Ferral H, Giusto D, Patel J, Van Thiel DH. Transjugular liver biopsy: comparison of sample adequacy with the use of two automated needle systems. J Vasc Interv Radiol 2010; 22:341-5. [PMID: 21194967 DOI: 10.1016/j.jvir.2010.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 09/12/2010] [Accepted: 10/18/2010] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare the adequacy of transjugular liver biopsy (TJLB) specimens with use of the 18-gauge Quick-Core and Flexcore needles. MATERIALS AND METHODS The records of 233 patients who underwent a TJLB procedure from January 2005 to December 2006 were retrospectively reviewed. Tissue samples from a total of 194 procedures were available for review; 117 TJLB procedures were performed with a Quick-Core needle and 77 were performed with a Flexcore needle. A single pathologist reviewed all the liver biopsy specimens in a blinded fashion. The χ(2), Fisher exact, and Student t tests were used to analyze differences between groups. RESULTS The TJLB procedure was technically successful in 232 of 233 cases (99.6%). Histologic diagnosis was possible in 96% of cases. Sample fragmentation rates were 24.9% with the Quick-Core needle and 14.3% with the Flexcore needle (P = .1). The mean numbers of complete portal tracts (CPTs) per submitted tissue per procedure were 10.0 ± 4.6 for the Quick-Core needle and 12.2 ± 6.1 for the Flexcore needle (P = .003). The mean numbers of CPTs per liver sample were 2.63 ± 1.8 for the Quick-Core needle and 3.28 ± 3.3 for the Flexcore needle (P = .00004). Complications were more common in patients with multiple comorbidities such as renal failure and coagulopathy and those who had received a liver transplant. CONCLUSIONS This study demonstrates that the 18-gauge Flexcore TJLB system provided better liver biopsy specimens compared with the 18-gauge Quick-Core needle system.
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Affiliation(s)
- George Behrens
- Section of Interventional Radiology, Department of Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL 60612, USA.
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13
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Clinical relevance of transjugular liver biopsy in comparison with percutaneous and laparoscopic liver biopsy. Gastroenterol Res Pract 2009; 2009:947014. [PMID: 19920868 PMCID: PMC2777243 DOI: 10.1155/2009/947014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/17/2009] [Accepted: 09/02/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Transjugular liver biopsy (TJLB) is frequently used to obtain liver specimens in high-risk patients. However, TJLB sample size possibly limits their clinical relevance. METHODS 102 patients that underwent TJLB were included. Clinical parameters and outcome of TJLB were analyzed. Control samples consisted of 112 minilaparoscopic liver biopsies (mLLBs) and 100 percutaneous liver biopsies (PLBs). RESULTS Fewer portal tracts were detected in TJLB (4.3 +/- 0.3) in comparison with PLB (11.7 +/- 0.5) and mLLB (11.0 +/- 0.6). No difference regarding the specification of indeterminate liver disease and staging/grading of chronic hepatitis was observed. In acute liver failure (n = 32), a proportion of hepatocellular necrosis beyond 25% was associated with a higher rate of death or liver transplantation. CONCLUSIONS Despite smaller biopsy samples the impact on the clinical decision process was found to be comparable to PLB and mLLB. TJLB represents a helpful tool to determine hepatocellular necrosis rates in patients with acute liver failure.
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14
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Calvaruso V, Burroughs AK, Standish R, Manousou P, Grillo F, Leandro G, Maimone S, Pleguezuelo M, Xirouchakis I, Guerrini GP, Patch D, Yu D, O'Beirne J, Dhillon AP. Computer-assisted image analysis of liver collagen: relationship to Ishak scoring and hepatic venous pressure gradient. Hepatology 2009; 49:1236-44. [PMID: 19133646 DOI: 10.1002/hep.22745] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Histopathological scoring of disease stage uses descriptive categories without measuring the amount of fibrosis. Collagen, the major component of fibrous tissue, can be quantified by computer-assisted digital image analysis (DIA) using histological sections. We determined relationships between DIA, Ishak stage, and hepatic venous pressure gradient (HVPG) reflecting severity of fibrosis. One hundred fifteen patients with hepatitis C virus (HCV) who had undergone transplantation had 250 consecutive transjugular liver biopsies combined with HVPG (median length, 22 mm; median total portal tracts, 12), evaluated using the Ishak system and stained with Sirus red for DIA. Liver collagen was expressed as collagen proportionate area (CPA). Median CPA was 6% (0.2-45), correlating with Ishak stage (stage 6 range, 13%-45%), and with HVPG (r = 0.62; P < 0.001). Median CPA was 4.1% when HVPG was less than 6 mm Hg and 13.8% when HVPG was 6 mm Hg or more (P < 0.0001) and 6% when HVPG was less than 10 mm Hg and 17.3% when HVPG was 10 mm Hg or higher (P < 0.0001). Only CPA, not Ishak stage/grade, was independently associated by logistic regression, with HVPG of 6 mm Hg or more [odds ratio, 1.206; 95% confidence interval (CI), 1.094-1.331; P < 0.001], or HVPG of 10 mm Hg or more (odds ratio, 1.105; 95% CI, 1.026-1.191; P = 0.009). CPA increased by 50% (3.6%) compared with 20% in HVPG (1 mm Hg) in 38 patients with repeated biopsies. CONCLUSION CPA assessed by DIA correlated with Ishak stage scores and HVPG measured contemporaneously. CPA was a better histological correlate with HVPG than Ishak stage, had a greater numerical change when HVPG was low, and resulted in further quantitation of fibrosis in cirrhosis.
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Affiliation(s)
- Vincenza Calvaruso
- The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, Royal Free Hospital, London, UK
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15
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Affiliation(s)
- Don C Rockey
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA.
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16
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A Comparison of Four- Versus Three-Pass Transjugular Biopsy Using a 19-G Tru-Cut Needle and a Randomized Study Using a Cassette to Prevent Biopsy Fragmentation. Cardiovasc Intervent Radiol 2008; 32:508-13. [DOI: 10.1007/s00270-008-9412-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 07/14/2008] [Accepted: 07/21/2008] [Indexed: 02/08/2023]
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Samonakis DN, Cholongitas E, Thalheimer U, Kalambokis G, Quaglia A, Triantos CK, Mela M, Manousou P, Senzolo M, Dhillon AP, Patch D, Burroughs AK. Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis. Liver Transpl 2007; 13:1305-11. [PMID: 17763383 DOI: 10.1002/lt.21227] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Progression of fibrosis following recurrent hepatitis C virus (HCV) infection is frequent after liver transplantation (LT). Histology remains the gold standard to assess fibrosis, but the value of hepatic venous pressure gradient (HVPG) is being explored. We evaluated patients with recurrent HCV infection after LT to assess whether HVPG correlates with liver histology, particularly fibrosis. A total of 90 consecutive patients underwent 170 HVPG measurements concomitant with transjugular liver biopsy (TJB), with 31.5 (range, 6-156) months of follow up. Median biopsy length was 22 mm and total portal tract count was 12 (complete 6, partial 6). Median HVPG was 4 mmHg: 38% of patients > or =6 mmHg (portal hypertension, PHT), 13% > or =10 mmHg. HVPG correlated with Ishak stage (r = 0.73, P < 0.001) for mild (0-3) and severe fibrosis (4-6), and grade score (r = 0.47, P < 0.001), but neither correlated with interval from LT nor biopsy length. HVPG was > or =10 mmHg in 15 patients: 12 had stage 5 or 6, and 3 severe portal expansion. HVPG was repeated in 49, between 7 and 60 months with weak correlation to fibrosis score (r = 0.30, P = 0.045). A total of 12 patients with HVPG > or =6 mmHg had fibrosis score < or =3, while 8 patients had normal HVPG but fibrosis stage > or =4. These discrepancies were mostly associated with specific histological features such as perisinusoidal fibrosis rather than errors in measuring HVPG. In 29 with HVPG <6 mmHg at 1 yr, none decompensated compared to 4 of 13 (31%) with PHT. In conclusion, HVPG correlates with fibrosis and its progression, due to recurrent HCV infection, assessed in TJB.
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Affiliation(s)
- Dimitrios N Samonakis
- Liver Transplantation and Hepatobiliary Unit and Histopathology Department, Royal Free Hospital, London, United Kingdom
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