A comparison of the accuracy of peritoneoscopy and liver biopsy in the diagnosis of cirrhosis

Abstract

(Scheuer, 1973): nodular regeneration, fragmentation of the biopsy with fibrosis at the margins and wide postnecrotic collapse with an abnormal relationship between portal tracts and central veins, and evidence of active liver-cell hyperplasia.In order to compare the findings by the two methods, only the cases diagnosed as cirrhosis by one or both procedures were selected. Necropsy was performed in 16 of these cases, confirming the diagnosis made. ResultsThe combination of both methods yielded a diagnosis of cirrhosis in 152 out of the 473 patients examined. A positive histological and peritoneoscopic diagnosis was obtained in 111 (73 %), and in 41 cases only one of the two procedures yielded the diagnosis. In the remaining 321 patients cirrhosis was excluded after the examination.Among the 41 cases in which a discrepancy was found, cirrhosis was diagnosed histologically in 27 and peritoneoscopically in 14. Thus the total number of 'apparent' positive results of peritoneoscopy was 125 (82.3 %) and of liver biopsy 138 (90.7 %/). The percentage of 'apparent' false-negative results is 17-7 % for peritoneoscopy and 9.3 % for liver biopsy.

Physician's use of laparoscopy.

“…When prothrombin times were severely prolonged ( > 6 s above control) biopsy was not used, but hepatic visualisation alone usually allowed a visual diagnosis to be reached. The false-negative rate for laparoscopic (visual) diagnosis of cirrhosis may be as high as 17.7 14 In our series (combined visualisation and biopsy) the false-negative rate for cirrhosis was 1 30o at follow-up.…”

Mini-Laparoscopy Is Superior in Detecting Liver Cirrhosis and Metastases in Liver Cancer: An Over 10-Year Experience in 1,788 Cases

“…This sample error of liver biopsy has been described in 17-32% of cases in many previous examinations matching macro- and microscopic findings in chronic liver disease [5,13,14,15], including randomized trials that compared laparoscopy and mini-laparoscopy with percutaneous liver biopsy [6,16]. Histologic understaging of the liver disease seems to be more frequent in early (Child A) and macronodular cirrhosis [17] and is clearly dependent on the quality of the biopsy cylinder [18,19].…”

La biopsia hepática en el Hospital Nacional Cayetano Heredia de 1969 a 1993

“…Es un método que ofrece muchas ventajas (10,11,12,13,14) y pensamos que debería ser de práctica más frecuente en un hospital universitario como es el nuestro.…”