Liver Biopsy: Importance of Specimen Size in the Diagnosis and Staging of Chronic Viral Hepatitis

Coral, Gabriela Perdomo; Antunes, Aline Dal Pozzo; Serafini, Ana Paula Almeida; Araújo, Fernanda B.; Mattos, Ângelo Alves de

doi:10.1590/s1678-9946201658010

Cited by 17 publications

(17 citation statements)

References 24 publications

(41 reference statements)

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“…To overcome this problem, primary antibodies selection was performed according to their high affinity for the antigen and in addition, secondary antibodies as well as suitable amplification systems were used in order to enhance the signal thus providing for higher sensitivity. On the other hand, despite the advantage of hepatic microenvironment studies, liver biopsy has been associated with sampling error, mostly due to suboptimal biopsy size that may not be an accurate representation of the whole organ; to minimize this only those specimens with 10 or more portal tracts were included . Lastly, it is reasonable to underline that our study only provides a snapshot of a specific time in HBV infection, and the hepatic microenvironment may fluctuate during the natural course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Chronic hepatitis B: The interplay between intrahepatic lymphocyte population and viral antigens in relation to liver damage

Giadans

Rios

Ameigeiras

et al. 2019

Journal of Viral Hepatitis

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In Chronic hepatitis B (CHB) infection, virus and immune response interplay is thoughtto be responsible for pathogenesis. Yet, the impact of each immune cell population and viral protein expression in liver damage is still unknown. Our aim was to study the interplay between intrahepatic immune response and viral activity in relation to CHB liver damage. Immunostaining was performed in 29 liver biopsies from untreated CHB patients to characterize liver infiltrate [Th (CD4+), CTL (CD8+), Treg (FoxP3+), Th17 (IL-17A+) and Th1 (T-bet+)] and viral antigen expression (HBsAg and HBcAg).Inflammatory activity and fibrosis were assessed using the HAI and METAVIR scoring system. All studied populations were identified in the portal-periportal (P-P) areas with a CD4+ lymphocyte predominance, while only CD8+ and FoxP3+ cells were observed in the intralobular area. Both P-P CD4+ and intralobular CD8+ cell frequencies were increased among severe hepatitis cases. Concerning HBsAg and HBcAg expression, a mutually exclusive pattern was observed. HBcAg was mainly detected among HBeAg-positive patients and was associated with hepatitis severity and higher frequency of P-P FoxP3+, intralobular CD8+ and FoxP3+ cells. HBsAg was identified among HBeAg-negative cases with less severe hepatitis grade and lower frequency of P-P CD4+ and intralobular FoxP3+ lymphocytes. In conclusion, the HBV antigen profile expression seen during CHB infection may be reflecting different stages of viral replication which impacts the host immune response and liver damage process. While HBcAg might be an inducer of a regulatory microenvironment, the intralobular CTL population seemed to have a key role in hepatitis severity. K E Y W O R D Schronic hepatitis B, inflammatory infiltrate, liver damage, viral antigen

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Section: Discussionmentioning

confidence: 99%

Chronic hepatitis B: The interplay between intrahepatic lymphocyte population and viral antigens in relation to liver damage

Giadans

Rios

Ameigeiras

et al. 2019

Journal of Viral Hepatitis

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“…These favorable results with qFibrosis are in contrast to those from studies with traditional methods demonstrating substantial sampling error [4, 6, 7, 17, 18]. For these methods, a relatively generous 2-cm-long sample is now recommended [8, 19], leading to increased peri-operative risk [10, 20].…”

Section: Discussionmentioning

confidence: 99%

SHG/TPEF-based image technology improves liver fibrosis assessment of minimally sized needle biopsies

et al. 2019

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Background and aims Sampling size variability of liver biopsy remains a major limitation in the assessment of liver fibrosis. We aimed to evaluate the diagnostic value of a fully quantitative method (second harmonic generation/two-photon excitation fluorescence, SHG/TPEF based) in “short” liver biopsy samples. Methods Liver biopsy samples from chronic hepatitis B (CHB) patients were constructed into “virtual” biopsies with different lengths. The original and “virtual” samples were measured by SHG/TPEF-based technology to obtain qFibrosis score, respectively. Here, ΔqFibrosis was defined as difference of qFibrosis between original biopsy and “virtual” biopsy. Equivalence test was used to compare ΔqFibrosis with the clinically acceptable error (deviation of 0.50) in each group. Results In real-world practice, qFibrosis score increased significantly with fibrosis progression in ≥ 1.5-cm-, 1.0–1.5-cm-, and 0.5–1.0-cm-long specimens ( p < 0.05), compared with ≤ 0.5-cm-long specimens ( p > 0.05). In virtual biopsy samples with specified length, the equivalence was confirmed in 0.5–1.0-cm- and 1.0–1.5-cm-long specimens (0.27 vs. 0.22, p < 0.001), whereas not in ≤ 0.5-cm-long specimens (0.53, p > 0.05). The number of cross-linked collagen fibers, the total and aggregated collagen proportionate area, and the collagen strings in number, length, width and perimeter showed excellent consistency with original biopsy samples in 0.5–1.0-cm- and 1.0–1.5-cm-long specimens (ICC > 0.90). Conclusions The use of SHG/TPEF-based image technology may give useful suggestive information in evaluation of CHB-related liver fibrosis for the short sample (biopsy length > 0.5 cm). Electronic supplementary material The online version of this article (10.1007/s12072-019-09955-2) contains supplementary material, which is available to authorized users.

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“…Diğer yandan, bu testleri fibroz durumunu iyi öngörebilen testler olarak öneren çalışmalar da mevcuttur ve bu test sonuçlarıyla birlikte çeşitli algoritmalar kullanarak hastalara biyopsi uygulanması ihtiyacının azaldığı vurgulanmaktadır (22). APRI, FIB4, FibroTest ® (Bi-oPredictive, Paris, Fransa) ve FibroScan ® gibi testleri, DSÖ de biyopsi ihtiyacını azaltmak ve tedavi ihtiyacı olan hastayı belirlemek için önermektedir (10,17). Bu testlerle yanlış pozitif ve negatif değerlendirmeler olabildiğinden bu testlerin yanında yaş, yüksek ALT ve HBV DNA seviyesi gibi diğer kriterlerin de kullanılması önerilmektedir (3,5).…”

Section: İrdelemeunclassified

Evaluation of HBeAg-Negative Chronic Hepatitis B Patients Who Had Undergone Liver Biopsy in Accordance With the Guidelines

Solak-Grassie¹,

Gozutok²,

Coşkun³

et al. 2018

Klimik Dergisi

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Objective: In HBeAg-negative patients who constitute most of the hepatitis B patients in our country, treatment decision is made according to biopsy result. Guidelines do not require biopsy in some patient groups and suggest the treatment decision with HBV DNA and alanine aminotransferase (ALT) level. Non-invasive fibrosis measurement tests can also be used to assess liver fibrosis status. In our study, we aimed to investigate fibrosis measurement tests' predictability of liver biopsy result which is an invasive procedure and to evaluate our patients in terms of guidelines and national treatment justification criteria. Methods: HBeAg-negative 25 patients who had undergone liver biopsy in our clinic were investigated retrospectively. Patients' demographic features, liver biopsy results, HBV DNA levels and treatment decisions were recorded. AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB4) scores were calculated. The correlation between APRI and FIB4 scores and biopsy results was investigated. Patients whom treatment could not be started were evaluated for eligibility according to guidelines. Results: With the biopsy results, the treatment was started in 15 patients while 10 (40%) of the patients could not be treated according to the valid national reimbursement regulations. Six of these 10 patients were the patients with high HBV DNA and ALT levels. APRI scores did not correlate with biopsy Ishak histologic activity index and fibrosis scores (p=0.4, p=0.3). FIB4 scores were in correlation with biopsy Ishak HAI scores (p=0.03) but did not correlate with fibrosis scores (p=0.5). Conclusions: In our study, it was understood that 40% of the patients who had undergone biopsy were not able to start treatment, and some of these patients were recommended to be treated without the necessity of liver biopsy according to the guidelines. Fibrosis tests are insufficient to predict liver biopsy results. It is thought that they cannot help to reduce the need for liver biopsy.

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Liver Biopsy: Importance of Specimen Size in the Diagnosis and Staging of Chronic Viral Hepatitis

Cited by 17 publications

References 24 publications

Chronic hepatitis B: The interplay between intrahepatic lymphocyte population and viral antigens in relation to liver damage

Chronic hepatitis B: The interplay between intrahepatic lymphocyte population and viral antigens in relation to liver damage

SHG/TPEF-based image technology improves liver fibrosis assessment of minimally sized needle biopsies

Evaluation of HBeAg-Negative Chronic Hepatitis B Patients Who Had Undergone Liver Biopsy in Accordance With the Guidelines

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