Red cell volume distribution width-to-platelet ratio in assessment of liver fibrosis in patients with chronic hepatitis B

Unexplained Chronically Elevated Aminotransferases: Liver Biopsy Gives Major Information with Therapeutic Implication in One Patient Out of Seven

BACKGROUND & AIMS

Liver biopsy contribution in patients with unexplained elevation of transaminases is not clearly established. The aim was to study liver biopsy contribution in patients with unexplained elevated transaminases strictly defined according to the current guidelines, reflecting the present clinical practice.

METHODS

In a retrospective study, we identified all the liver biopsies performed in patients with elevated transaminases for at least six months. Patients with a particular context, or with an identified cause of liver disease were excluded. The biopsies were classified according to the 4 following injury patterns: hepatitic, biliary, steatotic, vascular.

RESULTS

87 patients were included. Liver biopsy showed minimal changes or a normal histology in 48%, a steatotic pattern in 21%, a hepatitic pattern in 13%, a vascular pattern in 8%, a biliary pattern in 1%, and a mixed pattern in 8%. A cause could be determined in 21% of patients with normal histology, 85% with steatosis, 56% with hepatitis, 75% with biliary, but in none with isolated vascular pattern. Liver biopsy had important clinical and therapeutic implications in 15% of patients, with a diagnosis of autoimmune hepatitis, primary biliary cholangitis or metabolic dysfunction-associated steatohepatitis. Elevation of transaminases > 10 upper normal limit was present in all the patients with confirmed autoimmune hepatitis, but in only 7% of others.

CONCLUSION

Liver biopsy had important clinical and therapeutic implications in 15% of patients. However, the majority of patients had minimal changes without a cause, or minor vascular lesions of uncertain significance.

Rare Liver Diseases With Near-Normal Histology: A Review Focusing on Metabolic, Storage, and Inclusion Disorders

Despite the growing availability of noninvasive and faster diagnostic modalities, biopsy remains an important tool in the diagnosis and management of liver diseases. However, it is not uncommon that liver biopsies reveal normal or near normal histologic findings in patients with abnormal liver biochemistries, elevated autoantibodies, clinical findings suggestive of portal hypertension, systemic autoimmune or inflammatory diseases, hepatomegaly, cirrhosis by imaging, or other indications. These scenarios present significant diagnostic challenges and are rarely discussed in detail in the literature or textbooks. This article aims to provide a comprehensive review of a group of selected rare liver diseases, with a focus on metabolic, storage and inclusion disorders, that may exhibit a near-normal histology on biopsy. By recognizing subtle histologic features and correlating with clinical history, laboratory results and imaging findings, it is often possible to narrow down the differential diagnosis. In many cases, this integrative approach can yield a definitive diagnosis, allowing for tailored treatment and better patient outcomes.

The defining of the reference range of liver stiffness and fat attenuation parameter for healthy Chinese children

AIMS

We aimed to establish the basal reference levels of liver stiffness and accumulated fat in healthy Chinese children.

METHODS

To obtain the liver stiffness measurement (LSM) and the fat attenuation parameter (FAP) levels, the transient elastography (FibroTouch) was used in pediatric patients aged 0 to 18 years. The patients were divided into groups as follows: newborns/infants (0-2 years), preschool children (3-5 years), elementary school children (6-11 years), and adolescents/teenagers (12-18 years). The weight, height and fasting liver function tests were performed. FibroTouch and abdominal ultrasonography were performed.

RESULTS

The livers of 521 out of 1362 children (329 male; median age, 4.6 years; age range 0.2-17.6 years) were examined with the FibroTouch. The LSM reference range was 1.5-5.9 kPa, and the FAP reference range was 159.6-217.1 dB/m in healthy children from 0 to 18 years of age. The median LSM value was higher in males than that in females (3.5 vs. 3.2 kPa, respectively; P = 0.01).

CONCLUSION

For healthy children from 0 to 18 years in southern China, the LSM reference range was 1.5-5.9 kPa, and the FAP reference range was 159.6-217.1 dB/m. The LSM values were age-dependent in children from 3 to 18 years old, and the FAP values were age-independent in children from 0 to18 years old.

The Utility of Liver Biopsy in the Evaluation of Liver Disease and Abnormal Liver Function Tests

OBJECTIVES

We aimed to assess the value of liver biopsy in the evaluation of abnormal liver tests.

METHODS

We analyzed consecutive liver biopsy specimens performed for evaluation of unexplained abnormal liver tests from 2014 to 2018. Diagnoses were categorized histologically and clinically. We determined whether histologic examination led to a specific diagnosis and whether prebiopsy laboratory variables predicted the underlying etiology.

RESULTS

Among the 383 liver biopsy specimens included, chronic hepatitis was the most common histologic (25%) and clinical (17%) diagnosis. Liver biopsy led to a clinical diagnosis in 87% of patients. The most likely clinical diagnoses were autoimmune hepatitis, nonalcoholic fatty liver disease, and drug-induced liver injury (38, 33, and 32 patients, respectively). Using sensitivity, specificity, and positive and negative predictive values, we found that liver tests were not predictive of a specific diagnosis. In patients with no history of liver disease or clinical features of portal hypertension, biopsy specimens revealed histologic cirrhosis in 5% of patients.

CONCLUSIONS

Histopathologic diagnoses were made in 85% of patients undergoing liver biopsy for investigation of unexplained liver tests, leading to a clinical diagnosis in 87% of patients. However, neither liver tests themselves nor their patterns were useful in predicting histologic or clinical diagnoses.

The utility of liver biopsy in 2020

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.