Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Berger, Daniel; Desai, Vishal; Janardhan, Sujit

doi:10.1002/cld.740

Cited by 70 publications

(63 citation statements)

References 7 publications

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“…While MTX‐induced liver injury is uncommon, there is increasing evidence of its association with comorbid risk factors including diabetes, alcohol abuse, and obesity 1,2 . Current guidelines recommend monitoring liver function tests (LFTs) every one to three months, but this is often inadequate for detecting liver disease 3 . Liver biopsy remains the gold standard for identifying hepatic injury, yet it is invasive and has its own mortality risk.…”

Section: Fibrosis‐4 Score Risk Group Low <145 Moderate 145–325 Higmentioning

confidence: 99%

Utilizing Fibrosis‐4 score to assess risk for hepatic fibrosis in patients with psoriasis on methotrexate

et al. 2020

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Section: Fibrosis‐4 Score Risk Group Low <145 Moderate 145–325 Higmentioning

confidence: 99%

Utilizing Fibrosis‐4 score to assess risk for hepatic fibrosis in patients with psoriasis on methotrexate

et al. 2020

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“…Liver biopsy (LB), the gold standard for diagnosing NASH [ 11 ], has disadvantages, including risk of bleeding, sampling error, and inter-pathologist variability [ 12 ]. Recent innovations in imaging have demonstrated their potential in diagnosing NASH and advanced fibrosis [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis

et al. 2021

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Background and aims We investigated the usefulness of combining two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter for assessing the risk of progressive non-alcoholic steatohepatitis, defined as non-alcoholic steatohepatitis with a non-alcoholic fatty liver disease activity score of ≥4 and a fibrosis stage of ≥2. Methods This prospective study included 202 patients with non-alcoholic fatty liver disease who underwent two-dimensional shear wave elastography, ultrasound-guided attenuation parameter, vibration-controlled transient elastography, the controlled attenuation parameter, and liver biopsy on the same day. Patients were grouped according to liver stiffness measurement using two-dimensional shear wave elastography and the attenuation coefficient, assessed using the ultrasound-guided attenuation parameter: A, low liver stiffness measurement/low attenuation coefficient; B, low liver stiffness measurement/high attenuation coefficient; C, high liver stiffness measurement/low attenuation coefficient; and D, high liver stiffness measurement/high attenuation coefficient. Results Two-dimensional shear wave elastography and vibration-controlled transient elastography had equivalent diagnostic performance for fibrosis. The areas under the curve of the ultrasound-guided attenuation parameter for identifying steatosis grades ≥S1, ≥S2, and S3 were 0.89, 0.91, and 0.92, respectively, which were significantly better than those of the controlled attenuation parameter (P<0.05). The percentages of progressive non-alcoholic steatohepatitis in Groups A, B, C, and D were 0.0%, 7.7%, 35.7%, and 50.0%, respectively (P<0.001). The prediction model was established as logit (p) = 0.5414 × liver stiffness measurement (kPa) + 7.791 × attenuation coefficient (dB/cm/MHz)—8.401, with area under the receiver operating characteristic curve, sensitivity, and specificity values of 0.832, 80.9%, and 74.6%, respectively; there was no significant difference from the FibroScan-aspartate aminotransferase score. Conclusion Combined assessment by two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter is useful for risk stratification of progressive non-alcoholic steatohepatitis and may be convenient for evaluating the necessity of specialist referral and liver biopsy.

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“…LB keeps a place in the evaluation of liver fibrosis. All major liver and gastrointestinal society guidelines view LB as the gold standard for measuring liver fibrosis [4]. Noninvasive tests have not replaced liver biopsy but have clearly reduced the need for it.…”

Section: Introductionmentioning

confidence: 99%

Contribution, Indications and Technical Realization of Ultrasound-guided Liver Biopsy

Daoud¹,

Somaï²,

Hassen³

et al. 2019

IJG

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The liver biopsy (LB) still keeps some indications today, in spite of the progress of the non-invasive explorations. Several LB techniques have been studied. Some techniques use medical imaging. These techniques also differ in the material used to collect the hepatic sample. This study aimed to determine the current indications of LB, the interest using ultrasound guidance and an automatic device in order to improve its performance and its contribution to the diagnosis. This was a retrospective study including percutaneous LB performed under ultrasound guidance using automatic system equipped with a sharp needle. The study involved 50 patients with 26 diffuse liver diseases (DLD) and 24 focal liver lesions (FLL). The indications for DLD biopsy were dominated by suspicion of hepatic sarcoidosis, primary biliary cirrhosis and hepatic tuberculosis. FLL were dominated by the exploration of nodules or masses. The number of passes made was three in 96% of cases, otherwise it was four, with an average size of 1.3 cm for cores. DLD were dominated by chronic liver disease (42%), granulomatous hepatitis (23%), steatohepatitis (11%) and primary biliary cirrhosis (8%). FLL were dominated by secondary malignancies (46%) and primary malignant lesions (25%). For FLL, LB sensitivity, specificity, positive predictive value and negative predictive value were respectively 81%, 100%, 100% and 20%. LB confirmed 45% of DLD diagnoses, when they were well oriented by clinical and paraclinical data. The LB allowed to rectify the diagnosis in 54% of cases. When no initial diagnosis was suspected, LB enabled a specific diagnosis in 75% of cases. Major complications were void in our study. In conclusion, the use of ultrasound guidance and an automatic device with a sharp needle has increased the number of passes, improved the quality of sampling and reduced complications.

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Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/13-4-reading-berger a video presentation of this article

Cited by 70 publications

References 7 publications

Utilizing Fibrosis‐4 score to assess risk for hepatic fibrosis in patients with psoriasis on methotrexate

Utilizing Fibrosis‐4 score to assess risk for hepatic fibrosis in patients with psoriasis on methotrexate

Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis

Contribution, Indications and Technical Realization of Ultrasound-guided Liver Biopsy

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