Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease

Abstract

In the absence of surrogate markers, the evaluation of suspected nonalcoholic fatty liver disease (NAFLD) is highly dependent on histological examination. The extent of sampling variability affecting the reliability of a single liver biopsy in patients with suspected NAFLD is poorly characterized. This prospective study aimed to correlate precise histological findings in paired biopsies-right and left lobe-in the diagnosis of NAFLD in morbidly obese subjects undergoing bariatric surgery employing both Brunt and Matteoni classifications and the NAFLD Activity Score (NAS). We also aimed to determine whether the composite histopathological findings of the two biopsies would improve diagnostic accuracy. Consecutive subjects had an intraoperative biopsy from both right and left lobes, evaluated and scored in a blinded manner. Intraobserver agreement was also assessed. Kappa coefficients of agreement were calculated. Forty-one subjects had acceptable biopsies. Agreement for steatosis was excellent and moderate for fibrosis. Concordance was only fair for most features of necroinflammation. Intraobserver agreement was only moderate for lobular inflammation. Excellent agreement was seen for the diagnosis of NASH using Brunt criteria and good agreement when using Matteoni and NAS scoring systems. Composite biopsy data particularly improved identification of hepatocyte ballooning. The diagnostic accuracy also improved substantially when composite features were compared with single-sided biopsy features, especially for the Matteoni and NAS scoring systems. In conclusion, significant sampling variability occurs in NAFLD, particularly for features of necroinflammation. This should be factored into the design of clinical trials and studies of the natural history of the disease.

Automatic quantification of lobular inflammation and hepatocyte ballooning in nonalcoholic fatty liver disease liver biopsies

“…Looking at study results one may be led to believe patient-A's 3% improvement was more significant than patient-B's 24% improvement. The second limitation is semi-quantitative grading scale inevitably leads to inter and intra-rater variability (10,(12)(13)(14)(15)(16)(17). Rater variability will be amplified for cases that lie near a grading cutoff (threshold), and may worsen based on the skills and/or training of the rater.…”

Regional differences in hepatic fat fractions in over- weight children and adolescents observed by 3T 1H-MR spectroscopy

“…Visual histological assessment of "within liver" HFF variability showed excellent agreement for steatosis (κ=0.91 [25] and κ=0.88 [26] ) between the right and left lobes of the liver according to steatosis grading scale 0-3 in morbidly obese patients.…”

Gd-EOB-DTPA-enhanced MRI for the assessment of liver function and volume in liver cirrhosis

“…Non-alcoholic fatty liver disease has become the most common chronic liver disease in the Western world, with between 10% and 20% of the patients progressing to non-alcoholic steatohepatitis, which may in turn lead to liver cirrhosis [44][45][46]. In current practice, parenchymal dysfunction is encountered with increasing frequency in non-cirrhotic patients, and both chemotherapy-induced liver injury and metabolic syndrome-associated hepatic disease have been shown to be unevenly distributed in the liver [47][48][49].…”