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Kong F, Dong R, Chen G, Sun S, Yang Y, Jiang J, Meng L, Chen H, Zhu J, Zheng S. Progress in Biomarkers Related to Biliary Atresia. J Clin Transl Hepatol 2024; 12:305-315. [PMID: 38426193 PMCID: PMC10899875 DOI: 10.14218/jcth.2023.00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
Biliary atresia (BA) is a congenital cholestatic disease that can seriously damage children's liver function. It is one of the main reasons for liver transplantation in children. Early diagnosis of BA is crucial to the prognosis of patients, but there is still a lack of reliable non-invasive diagnostic methods. Additionally, as some children are in urgent need of liver transplantation, evaluating the stage of liver fibrosis and postoperative native liver survival in children with BA using a straightforward, efficient, and less traumatic method is a major focus of doctors. In recent years, an increasing number of BA-related biomarkers have been identified and have shown great potential in the following three aspects of clinical practice: diagnosis, evaluation of the stage of liver fibrosis, and prediction of native liver survival. This review focuses on the pathophysiological function and clinical application of three novel BA-related biomarkers, namely MMP-7, FGF-19, and M2BPGi. Furthermore, progress in well-known biomarkers of BA such as gamma-glutamyltransferase, circulating cytokines, and other potential biomarkers is discussed, aiming to provide a reference for clinical practice.
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Affiliation(s)
- Fanyang Kong
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Rui Dong
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Gong Chen
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Song Sun
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Yifan Yang
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Jingying Jiang
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Lingdu Meng
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Huifen Chen
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Jiajie Zhu
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
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Ferrasi AC, Lima SVG, Galvani AF, Delafiori J, Dias-Audibert FL, Catharino RR, Silva GF, Praxedes RR, Santos DB, Almeida DTDM, Lima EO. Metabolomics in chronic hepatitis C: Decoding fibrosis grading and underlying pathways. World J Hepatol 2023; 15:1237-1249. [DOI: 10.4254/wjh.v15.i11.1237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Chronic Hepatitis C (CHC) affects 71 million people globally and leads to liver issues such as fibrosis, cirrhosis, cancer, and death. A better understanding and prognosis of liver involvement are vital to reduce morbidity and mortality. The accurate identification of the fibrosis stage is crucial for making treatment decisions and predicting outcomes. Tests used to grade fibrosis include histological analysis and imaging but have limitations. Blood markers such as molecular biomarkers can offer valuable insights into fibrosis.
AIM To identify potential biomarkers that might stratify these lesions and add information about the molecular mechanisms involved in the disease.
METHODS Plasma samples were collected from 46 patients with hepatitis C and classified into fibrosis grades F1 (n = 13), F2 (n = 12), F3 (n = 6), and F4 (n = 15). To ensure that the identified biomarkers were exclusive to liver lesions (CHC fibrosis), healthy volunteer participants (n = 50) were also included. An untargeted metabolomic technique was used to analyze the plasma metabolites using mass spectrometry and database verification. Statistical analyses were performed to identify differential biomarkers among groups.
RESULTS Six differential metabolites were identified in each grade of fibrosis. This six-metabolite profile was able to establish a clustering tendency in patients with the same grade of fibrosis; thus, they showed greater efficiency in discriminating grades.
CONCLUSION This study suggests that some of the observed biomarkers, once validated, have the potential to be applied as prognostic biomarkers. Furthermore, it suggests that liquid biopsy analyses of plasma metabolites are a good source of molecular biomarkers capable of stratifying patients with CHC according to fibrosis grade.
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Affiliation(s)
| | | | - Aline Faria Galvani
- Department of Internal Medicine, Sao Paulo State University, Botucatu 18618-686, Brazil
| | - Jeany Delafiori
- Innovare Biomarkers Laboratory, University of Campinas, Campinas 13083-877, Brazil
| | | | | | - Giovanni Faria Silva
- Department of Internal Medicine, Sao Paulo State University, Botucatu 18618-686, Brazil
| | | | | | | | - Estela Oliveira Lima
- Department of Internal Medicine, Sao Paulo State University, Botucatu 18618-686, Brazil
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Okasha HH, Delsa H, Alsawaf A, Hashim AM, Khattab HM, Abdelfatah D, Abdellatef A, Albitar A. Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions. World J Methodol 2023; 13:287-295. [PMID: 37771875 PMCID: PMC10523253 DOI: 10.5662/wjm.v13.i4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/23/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has become an established method in diagnostic and therapeutic procedures in gastroenterology; however, it has recently gained a growing role in hepatology. AIM To evaluate the role of EUS features, strain elastography (SE), and EUS-tissue acquisition in diagnosing hepatic focal lesions (HFLs) that could affect further management. METHODS This cross-sectional study included 215 patients with pancreatic, biliary, or gastrointestinal malignancies referred for EUS examination. HFLs were identified in 43 patients (20%), and EUS-guided tissue acquisition was performed from these lesions. RESULTS EUS features were highly sensitive (100%) but much less specific (57%) in diagnosing HFLs; the overall accuracy was 94%. Real-time elastography was also very sensitive (97%) but less specific (67%) in diagnosing HFLs; however, the overall accuracy was 92%. EUS tissue acquisition was extremely sensitive (100%) and specific (100%), with a 100% overall diagnostic accuracy. CONCLUSION The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs. EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Hanane Delsa
- Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
- Research Unit, Mohammed VI Center for Research and Innovation, Rabat 10100, Morocco
| | - Abdelmoneim Alsawaf
- Department of Gastroenterology, Barnsley NHS Foundation Trust, Barnsley S75 2EP, United Kingdom
| | - Ahmed Morad Hashim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Hani M Khattab
- Department of Pathology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11451, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Amr Albitar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
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Natali GL, Cassanelli G, Paolantonio G, Parapatt GK, Gregori LM, Rollo M. Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt. Pediatr Radiol 2023; 53:727-738. [PMID: 36121496 PMCID: PMC10027841 DOI: 10.1007/s00247-022-05492-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
Cirrhosis is a complex diffuse process whereby the architecture of the liver is replaced by abnormal nodules because of the presence of fibrosis. Several pediatric diseases such as extrahepatic portal vein obstruction, biliary atresia, alpha-1-antitrypsin deficit and autoimmune hepatitis can lead to cirrhosis and portal hypertension in children. In this article the authors describe interventional radiology procedures that can facilitate the diagnosis and treatment of diseases associated with liver cirrhosis and portal hypertension in the pediatric population. These procedures include image-guided liver biopsy, mesenteric-intrahepatic left portal vein shunts, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunts and splenic embolization.
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Affiliation(s)
- Gian Luigi Natali
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
| | - Giulia Cassanelli
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy
| | | | | | | | - Massimo Rollo
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Rangwani S, Ardeshna DR, Mumtaz K, Kelly SG, Han SY, Krishna SG. Update on endoscopic ultrasound-guided liver biopsy. World J Gastroenterol 2022; 28:3586-3594. [PMID: 36161047 PMCID: PMC9372801 DOI: 10.3748/wjg.v28.i28.3586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a minimally-invasive alternative to the traditional (percutaneous or transjugular) liver biopsy techniques for the diagnosis of liver parenchymal diseases. Po-tentially, EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure. Additionally, EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy. Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield, increased acquisition of complete portal tracts, and longer specimen length as compared to the traditional approaches. EUS-LB is associated with lesser post-procedural pain and shorter recovery time, while providing lower risk of complications when compared to traditional liver biopsy. Innovations in needle types, needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique. This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB, and compares EUS-LB with traditional methods of liver biopsy.
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Affiliation(s)
- Shiva Rangwani
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Devarshi R Ardeshna
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Sean G Kelly
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Samuel Y Han
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Möller K, Dietrich CF, Faiss S, Mutze S, Goelz L. [Alternatives of histological material collection - When and how is histological confirmation by ultrasound (US), computer tomography (CT) or endosonography (EUS) useful?]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:937-958. [PMID: 34781389 DOI: 10.1055/a-1482-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological classifications of tumorous lesions together with adequate staging are necessary for stage-appropriate and personalized therapies. The indications, technical possibilities, and limitations as well as potential complications of image-guided needle biopsy by ultrasound, computed tomography, and endosonography are described. Which procedure for which organ and which lesion?
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Affiliation(s)
- Kathleen Möller
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | | | - Siegbert Faiss
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | - Sven Mutze
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany
- Institut für Radiologie, SANA-Klinikum, Berlin, Germany
- Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany
- Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
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Dhar J, Samanta J. Role of endoscopic ultrasound in the field of hepatology: Recent advances and future trends. World J Hepatol 2021; 13:1459-1483. [PMID: 34904024 PMCID: PMC8637671 DOI: 10.4254/wjh.v13.i11.1459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/19/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
The role of endoscopic ultrasound (EUS) as a diagnostic and therapeutic modality for the management of various gastrointestinal diseases has been expanding. The imaging or intervention for various liver diseases has primarily been the domain of radiologists. With the advances in EUS, the domain of endosonologists is rapidly expanding in the field of hepatology. The ability to combine endoscopy and sonography in one hybrid device is a unique property of EUS, together with the ability to bring its probe/transducer near the liver, the area of interest. Its excellent spatial resolution and ability to provide real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS, have facilitated the growth of EUS. The concept of "Endo-hepatology" encompasses the wide range of diagnostic and therapeutic procedures that are now gradually becoming feasible for managing various liver diseases. Diagnostic advancements can enable a wide array of techniques from elastography and liver biopsy for liver parenchymal diseases, to CE-EUS for focal liver lesions to portal pressure measurements for managing various liver conditions. Similarly, therapeutic advancements range from EUS-guided eradication of varices, drainage of bilomas and abscesses to various EUS-guided modalities of liver tumor management. We provide a comprehensive review of all the different diagnostic and therapeutic EUS modalities available for the management of various liver diseases. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.
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Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Fujinaga Y, Namisaki T, Takaya H, Tsuji Y, Suzuki J, Shibamoto A, Kubo T, Iwai S, Tomooka F, Takeda S, Fujimoto Y, Enomoto M, Murata K, Ishida K, Ogawa H, Takagi H, Ozutsumi T, Furukawa M, Nishimura N, Sawada Y, Kitagawa K, Sato S, Kaji K, Kawaratani H, Moriya K, Noguchi R, Akahane T, Mitoro A, Yoshiji H. Enhanced liver fibrosis score as a surrogate of liver-related complications and mortality in primary biliary cholangitis. Medicine (Baltimore) 2021; 100:e27403. [PMID: 34596167 PMCID: PMC8483841 DOI: 10.1097/md.0000000000027403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/05/2023] Open
Abstract
The presence of bridging fibrosis predicts survival of primary biliary cholangitis (PBC). This study aimed to compare serum parameters for the estimation of liver fibrosis and prediction of clinical outcomes in PBC.Out of 392 patients with PBC, 102 who underwent liver biopsy and in whom fibrosis indices, platelet count, hyaluronic acid, type IV collagen 7 second domain, procollagen type III amino-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, N-terminal type III collagen propeptide levels; fibrosis index based on 4 factors, aspartate aminotransferase-to-platelet ratio index, and enhanced liver fibrosis (ELF) score were determined, were included. The correlation of histological stages based on both Scheuer and Nakanuma classifications with fibrosis indices was investigated. The Nakanuma system comprises grading for liver fibrosis and bile duct loss. Diagnostic performances of 10 fibrosis indices were evaluated to identify patients with poor prognosis. Moreover, correlations of those with PBC clinical manifestation and survival were also investigated.Enhances liver fibrosis (ELF) score had the highest correlation coefficient for liver fibrosis evaluated according to either the Scheuer or Nakanuma classification among 10 serum fibrosis indices. It also had the highest diagnostic performance in estimating Scheuer stage III and Nakanuma fibrosis score 2, both of which represent portal-bridging fibrosis. Patients with an ELF score of ≥10.0 had shorter survival and presented more frequently clinical complications than those with an ELF score of <10.0.ELF score determines the severity of liver fibrosis and predicts the occurrence of complications and survival in patients with PBC.
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Vetter M, Kremer AE, Agaimy A, Pfeifer L, Neurath MF, Siebler J, Zopf S. How Much Liver Tissue Is Required for Sufficient Histological Staging in Patients with Primary Biliary Cholangitis? Digestion 2021; 102:428-436. [PMID: 32492681 DOI: 10.1159/000507392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Histological alterations in primary biliary cholangitis (PBC) are heterogeneously distributed throughout the liver. Thus, the quality of histological staging is probably dependent on the available amount of liver tissue. The goals of this study were to test this hypothesis and to define biopsy conditions for obtaining sufficient tissue. METHODS In this retrospective analysis, we investigated 34 patient cases who fulfilled the criteria of the European Association for the Study of the Liver (EASL) for PBC and underwent a mini-laparoscopic liver biopsy between 2011 and 2018 using 16 or 18G needles. For histological assessment of fibrosis, we used the Ishak score, and the amount of tissue was measured by the number of portal fields. Histological staging was compared with the macroscopic mini-laparoscopic fibrosis score (MLFS), and non-invasive liver stiffness measurements using acoustic radiation force impulse (ARFI) imaging and the FIB-4 score. RESULTS Biopsy was successful in 33 of 34 patients (97%). Fibrosis assessment by MLFS and ARFI correlated strongly with each other (r = 0.7088, p = 0.000017). However, the correlation of both methods with the histological staging was weaker (MLFS vs. histology: r = 0.4231, p = 0.0142; ARFI vs. histology: r = 0.3564, p = 0.0577). The correlation of ARFI and MLFS with the histological staging was better in the subgroup of biopsies with at least 10 portal fields (= SG≥10PF) (MLFS vs. histology: r = 0.6369, p = 0.006; ARFI vs. histology: r = 0.7538, p = 0.0012). FIB-4 correlated weakly with the histological staging, which was statistically not significant (all samples: r = 0.2693, p = 0.1296; SG≥10PF: r = 0.2244, p = 0.3866). The number of portal fields correlated well with the length of the samples (r = 0.6436, p = 0.00012). The probability to attain at least 10 portal fields depended on the needle diameter and number of samples (1 × 16G or 18G [n = 10]: 30.0%; 2 × 18G [n = 15]: 53.3%; 2 × 16G [n = 5]: 100%; p = 0.0414). CONCLUSION ARFI and MLFS are probably well suited for the assessment of liver fibrosis in patients with PBC. A minimum of 10 portal fields could improve the histological assessment in PBC and can probably be achieved by obtaining two 16G biopsies.
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Affiliation(s)
- Marcel Vetter
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas E Kremer
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lukas Pfeifer
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Siebler
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Steffen Zopf
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany, .,Department of Medicine 2, Klinikum Fürth, Fürth, Germany,
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van de Berg NJ, Meeuwsen FC, Doukas M, Kronreif G, Moelker A, van den Dobbelsteen JJ. Steerable needles for radio-frequency ablation in cirrhotic livers. Sci Rep 2021; 11:309. [PMID: 33431965 PMCID: PMC7801671 DOI: 10.1038/s41598-020-77869-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/05/2020] [Indexed: 12/09/2022] Open
Abstract
Accurate needle placement in deep-seated liver tumours can be difficult. In this work, we disclose two new manually controlled steerable needles for 17G radio-frequency ablation probe placement. The needles contain stylets with embedded compliant joints for active tip articulations, and concentric tubes for (curved-path) guidance. Needle steering was evaluated sequentially by intended users and in intended-use tissue types. Six interventional radiologists evaluated the needle in repeated ultrasound-guided steering tasks in liver-mimicking phantoms. Targets were located at a 100 mm depth and 20 mm lateral offset from the initial insertion line. The resulting mean absolute tip placement error was 1.0 ± 1.0 mm. Subsequently, steering-induced tissue damage was evaluated in fresh cirrhotic human liver explants. The surface area of puncture holes was estimated in scanned histology slides, using a connected-components analysis. The mean surface area was 0.26 ± 0.16 mm2 after steering with a median radius of curvature of 0.7 × 103 mm, versus 0.35 ± 0.15 mm2 after straight-path insertions with the steerable needle and 0.15 ± 0.09 mm2 after straight-path RFA probe insertions. The steering mechanisms proposed enable clinically relevant path corrections for 17G needles. Radiologists were quickly adept in curved-path RFA probe placement and the evaluation of histological tissue damage demonstrated a potentially safe use during liver interventions.
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Affiliation(s)
- Nick J van de Berg
- Dept. of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands. .,Dept. of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Frédérique C Meeuwsen
- Dept. of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michail Doukas
- Dept. of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria
| | - Adriaan Moelker
- Dept. of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John J van den Dobbelsteen
- Dept. of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Wang R, Zang W, Hu B, Deng D, Ling X, Zhou H, Su M, Jiang J. Serum ESPL1 Can Be Used as a Biomarker for Patients With Hepatitis B Virus-Related Liver Cancer: A Chinese Case-Control Study. Technol Cancer Res Treat 2020; 19:1533033820980785. [PMID: 33308056 PMCID: PMC7739072 DOI: 10.1177/1533033820980785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS To investigate the feasibility of serum extra spindle pole bodies-like 1 (ESPL1) used as a biomarker for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODS 131 chronic HBV-infection patients were recruited and divided into HBV S gene integration, non-HBV S gene integration, chronic hepatitis B (CHB), HBV-related liver cirrhosis (LC) and HBV-related HCC group, 24 non-HBV-related HCC patients were selected as HCC control group, 30 people without HBV-infection as healthy control group. Serum ESPL1 were detected and compared. RESULTS ESPL1 level of integration group was significantly higher than that of non-integration group (346.7 vs 199.6 ng/ml, P = 0.000) and healthy control group (346.7 vs 41.3 ng/ml, P = 0.000). ESPL1 level of non-integration group was significantly higher than that of healthy control group (199.6 vs 41.3 ng/ml, P = 0.000); ESPL1 levels in chronic HBV-infection related groups were increased in turn according to CHB group (95.8 ng/ml), HBV-related LC group (268.2 ng/ml), HBV-related HCC group (279.9 ng/ml) and integration group (346.7 ng/ml). Except that there was no significant difference in ESPL1 levels between HBV-related LC and HCC group (P = 0.662), pairwise comparisons between other groups showed significant differences (P < 0.05). ESPL1 level of HBV-related HCC group was significantly higher than that of non-HBV-related HCC group (279.9 vs 46.6 ng/ml, P = 0.000), there was no noticeable difference between non-HBV-related HCC and healthy control group (46.6 vs 41.3 ng/ml, P = 0.848). ESPL1 level of HBV-related HCC group after resection was significantly lower than that of before resection (178.4 vs 260.8 ng/ml, P = 0.000). CONCLUSIONS Chronic HBV-infection patients with high ESPL1 level may indicate HBV S gene integration and is a high-risk population for HBV-related HCC. Serum ESPL1 can be used as a biomarker for screening HBV-related HCC high-risk population and monitoring recurrence.
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Affiliation(s)
- Rongming Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Weiwei Zang
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Bobin Hu
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Deli Deng
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiaozhang Ling
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Huikun Zhou
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Minghua Su
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jianning Jiang
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Serag D, Ragab E. Diffusion-weighted MRI in staging of post hepatitis C fibrosis: does ADC value challenge liver biopsy? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is obvious interest in finding a non-invasive diagnostic tool to detect the development of hepatic fibrosis and distinguish between its various stages. Chronic inflammation of the liver secondary to viral hepatitis, autoimmune conditions, sclerosing cholangitis, drug toxicity, chronic alcohol intake, different metabolic disorders, and steatosis lead to fibrosis and maybe cirrhosis. The current study aimed to assess the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in diagnosis of post hepatitis C fibrosis and detection of its stage.
Results
A prospective study had included 232 participants; 120 patients had chronic hepatitis C with/without HCC and 112 subjects had normal liver. There was no significant difference between the two groups regarding age or gender (p 0.192 and 0.227 respectively). DW-MRI was performed using 1.5 T machine. The mean liver ADC values and normalized liver ADC (liver ADC/spleen ADC) were measured at b value 800 s/mm2; both were significantly lower among cases than controls. Cutoff values of liver ADC were 1.531 × 10−3 mm2/s, 1.409 × 10−3 mm2/s, 1.192 × 10−3 mm2/s, and 1.093 × 10−3 mm2/s for METAVIR stages ≥ F1, ≥ F2, ≥ F3, and F4, respectively. Normalized liver ADC showed larger area under the curve (AUC) than mean liver ADC in all differentiation categories except for differentiating between F0 and all other fibrosis stages.
Conclusion
In line with the literature, DW-MR imaging using b value of 800 s/mm2 has proved to be a valuable diagnostic technique for detection and staging of post hepatitis C fibrosis/cirrhosis being noninvasive procedure with acceptable accuracy. DWI using liver/spleen ADC values raised the diagnostic performance with AUC more than 90% in all fibrosis stages on METAVIR score.
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McCarty TR, Bazarbashi AN, Njei B, Ryou M, Aslanian HR, Muniraj T. Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis. Clin Endosc 2020; 53:583-593. [PMID: 33027584 PMCID: PMC7548145 DOI: 10.5946/ce.2019.211] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB.
Methods Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included.
Results Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005).
Conclusions EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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An Improved qFibrosis Algorithm for Precise Screening and Enrollment into Non-Alcoholic Steatohepatitis (NASH) Clinical Trials. Diagnostics (Basel) 2020; 10:diagnostics10090643. [PMID: 32872090 PMCID: PMC7554942 DOI: 10.3390/diagnostics10090643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Many clinical trials with potential drug treatment options for non-alcoholic fatty liver disease (NAFLD) are focused on patients with non-alcoholic steatohepatitis (NASH) stages 2 and 3 fibrosis. As the histological features differentiating stage 1 (F1) from stage 2 (F2) NASH fibrosis are subtle, some patients may be wrongly staged by the in-house pathologist and miss the opportunity for enrollment into clinical trials. We hypothesized that our refined artificial intelligence (AI)-based algorithm (qFibrosis) can identify these subtle differences and serve as an assistive tool for in-house pathologists. Methods: Liver tissue from 160 adult patients with biopsy-proven NASH from Singapore General Hospital (SGH) and Peking University People’s Hospital (PKUH) were used. A consensus read by two expert hepatopathologists was organized. The refined qFibrosis algorithm incorporated the creation of a periportal region that allowed for the increased detection of periportal fibrosis. Consequently, an additional 28 periportal parameters were added, and 28 pre-existing perisinusoidal parameters had altered definitions. Results: Twenty-eight parameters (20 periportal and 8 perisinusoidal) were significantly different between the F1 and F2 cases that prompted a change of stage after a careful consensus read. The discriminatory ability of these parameters was further demonstrated in a comparison between the true F1 and true F2 cases as 26 out of the 28 parameters showed significant differences. These 26 parameters constitute a novel sub-algorithm that could accurately stratify F1 and F2 cases. Conclusion: The refined qFibrosis algorithm incorporated 26 novel parameters that showed a good discriminatory ability for NASH fibrosis stage 1 and 2 cases, representing an invaluable assistive tool for in-house pathologists when screening patients for NASH clinical trials.
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15
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Laursen TL, Sandahl TD, Kazankov K, George J, Grønbæk H. Liver-related effects of chronic hepatitis C antiviral treatment. World J Gastroenterol 2020; 26:2931-2947. [PMID: 32587440 PMCID: PMC7304101 DOI: 10.3748/wjg.v26.i22.2931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/26/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
More than five years ago, the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral (DAA) drugs. They proved highly efficient in curing patients with chronic hepatitis C (CHC), including patients with cirrhosis. The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis, but the exact cause of the expected benefit was unclear. Further, little was known about how the underlying liver disease would be affected during and after viral clearance. In this review, we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects, such as macrophage activation, and the time-dependent effects of therapy, with specific emphasis on inflammation, structural liver changes, and liver function, as these factors are all related to morbidity and mortality in CHC patients. It seems clear that antiviral therapy, especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis. There seems to be a time-dependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions. These improvements lead to favorable effects on liver function, followed by an improvement in cognitive dysfunction and portal hypertension. Overall, the data provide knowledge on the several beneficial effects of DAA therapy on liver-related parameters in CHC patients suggesting short- and long-term improvements in the underlying disease with the promise of an improved long-term prognosis.
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Affiliation(s)
- Tea L Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Thomas D Sandahl
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Konstantin Kazankov
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney NSW 2145, Australia
- University of Sydney, Sydney NSW 2145, Australia
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
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Johnson KD, Laoveeravat P, Yee EU, Perisetti A, Thandassery RB, Tharian B. Endoscopic ultrasound guided liver biopsy: Recent evidence. World J Gastrointest Endosc 2020; 12:83-97. [PMID: 32218888 PMCID: PMC7085945 DOI: 10.4253/wjge.v12.i3.83] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/26/2019] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy (LB) is an essential tool in diagnosing, evaluating and managing various diseases of the liver. As such, histopathological results are critical as they establish or aid in diagnosis, provide information on prognosis, and guide the appropriate selection of medical therapy for patients. Indications for LB include evaluation of persistent elevation of liver chemistries of unclear etiology, diagnosis of chronic liver diseases such as Wilson's disease, autoimmune hepatitis, small duct primary sclerosing cholangitis, work up of fever of unknown origin, amyloidosis and more. Traditionally, methods of acquiring liver tissue have included percutaneous LB (PCLB), transjugular LB (TJLB) or biopsy taken surgically via laparotomy or laparoscopy. However, traditional methods of LB may be inferior to newer methods. Additionally, PCLB and TJLB carry higher risks of adverse events and complications. More recently, endoscopic ultrasound guided LB (EUS-LB) has evolved as an alternative method of tissue sampling that has proven to be safe and effective, with limited adverse events. Compared to PC and TJ routes, EUS-LB may also have a greater diagnostic yield of tissue, be superior for a targeted approach of focal lesions, provide higher quality images and allow for greater patient comfort. These advantages have contributed to the increased use of EUS-LB as a technique for obtaining liver tissue. Herein, we provide a review of the recent evidence of EUS-LB for liver disease.
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Affiliation(s)
- Kemmian D Johnson
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Eric U Yee
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Abhilash Perisetti
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Ragesh Babu Thandassery
- Department of Internal Medicine, Division of Gastroenterology, Central Arkansas Veterans Health Care System, Little Rock, AR 72205, United States
| | - Benjamin Tharian
- Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
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Patel K, Sebastiani G. Limitations of non-invasive tests for assessment of liver fibrosis. JHEP Rep 2020; 2:100067. [PMID: 32118201 PMCID: PMC7047178 DOI: 10.1016/j.jhepr.2020.100067] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
The diagnostic assessment of liver injury is an important step in the management of patients with chronic liver disease (CLD). Although liver biopsy is the reference standard for the assessment of necroinflammation and fibrosis, the inherent limitations of an invasive procedure, and need for repeat sampling, have led to the development of several non-invasive tests (NITs) as alternatives to liver biopsy. Such non-invasive approaches mostly include biological (serum biomarker algorithms) or physical (imaging assessment of tissue stiffness) assessments. However, currently available NITs have several limitations, such as variability, inadequate accuracy and risk factors for error, while the development of a newer generation of biomarkers for fibrosis may be limited by the sampling error inherent to the reference standard. Many of the current NITs were initially developed to diagnose significant fibrosis in chronic hepatitis C, subsequently refined for the diagnosis of advanced fibrosis in patients with non-alcoholic fatty liver disease, and further adapted for prognostication in CLD. An important consideration is that despite their increased use in clinical practice, these NITs were not designed to reflect the dynamic process of fibrogenesis, differentiate between adjacent disease stages, diagnose non-alcoholic steatohepatitis, or follow longitudinal changes in fibrosis or disease activity caused by natural history or therapeutic intervention. Understanding the strengths and limitations of these NITs will allow for more judicious interpretation in the clinical context, where NITs should be viewed as complementary to, rather than as a replacement for, liver biopsy.
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Key Words
- AGA, American Gastroenterology Association
- ALT, alanine aminotransferase
- APRI, AST-platelet ratio index
- AST, aspartate aminotransferase
- AUC, area under the curve
- BMI, body mass index
- Biomarkers
- CAP, controlled attenuation parameter
- CHB, chronic hepatitis B
- CHC, chronic hepatitis C
- CLD, chronic liver disease
- CPA, collagen proportionate area
- DAA, direct-acting antiviral
- ELF, enhanced liver fibrosis
- Elastography
- FIB-4, fibrosis-4
- FLIP, fatty liver inhibition of progression
- HCC, hepatocellular carcinoma
- IFN, interferon
- LSM, liver stiffness measure
- Liver biopsy
- MR, magnetic resonance
- MRE, magnetic resonance elastography
- NAFLD, non-alcoholic fatty liver disease
- NFS, NAFLD fibrosis score
- NITs, non-invasive tests
- Non-alcoholic fatty liver disease
- SVR, sustained virologic response
- US, ultrasound
- VCTE, vibration-controlled transient elastography
- Viral hepatitis
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Affiliation(s)
- Keyur Patel
- Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, ON, Canada
- Corresponding author. Address: Division of Gastroenterology, University of Toronto Health Network, Toronto General Hospital, 200 Elizabeth Street, 9EN, Toronto, ON M5G 2C4.
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada
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Di Tommaso L, Spadaccini M, Donadon M, Personeni N, Elamin A, Aghemo A, Lleo A. Role of liver biopsy in hepatocellular carcinoma. World J Gastroenterol 2019; 25:6041-6052. [PMID: 31686761 PMCID: PMC6824282 DOI: 10.3748/wjg.v25.i40.6041] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known cirrhosis. In fact, in the diagnostic algorithm for this tumor, histology is currently relegated to controversial cases. Furthermore, the risk of complications, such as tumor seeding and bleeding, as well as inadequate sampling have further limited the use of liver biopsy for HCC management. However, there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and, as the information content of the tissue sample increases, the advantages of liver biopsy might modify the current risk/benefit ratio. We herein review the role and potentiality of liver biopsy in the diagnosis and management of HCC. As the potentiality of precision medicine comes to the management of HCC, it will be crucial to have rapid pathways to define prognosis, and even treatment, by identifying the patients who could most benefit from target-driven therapies. All of the above reasons suggest that the current role of liver biopsy in the management of HCC needs substantial reconsideration.
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Affiliation(s)
- Luca Di Tommaso
- Pathology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
| | - Matteo Donadon
- Division of Hepatobiliary and General Surgery, Department of General Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
| | - Nicola Personeni
- Division of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
| | - Abubaker Elamin
- Pathology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
| | - Ana Lleo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
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Kishanifarahani Z, Ahadi M, Kazeminejad B, Mollasharifi T, Saber Afsharian M, Sadeghi A, Bidari F, Jamali E, Hasanzadeh N, Movafagh A, Dehghan A, Moradi A, Moradi A. Inter-observer Variability in Histomorphological Evaluation of Non-neoplastic Liver Biopsy Tissue and Impact of Clinical Information on Final Diagnosis in Shahid Beheshti University of Medical Sciences Affiliated Hospitals. IRANIAN JOURNAL OF PATHOLOGY 2019; 14:243-247. [PMID: 31583002 PMCID: PMC6742738 DOI: 10.30699/ijp.2019.99566.1985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/28/2019] [Indexed: 12/28/2022]
Abstract
Background & Objective: Liver biopsy is the main method for grading and staging liver disorders, but the effects of clinical information and optimal biopsy specimen size on interpretation remain contentious. The aim of the study was to evaluate the impact of clinical information and quality of liver specimen on inter-observer agreement for liver disease. Methods: A total of 289 consecutive biopsy specimens from 2010 to 2017 were re-evaluated by five pathologists using the modified Ishak and non-alcoholic fatty liver diseases (NAFLD) activity score (NAS) systems. Detailed clinical information was extracted from medical records of patients and the size of all liver biopsy samples was recorded. Results: Full agreement between primary diagnosis and final diagnosis was obtained in 214 cases (74%). The remaining cases, namely 22 (7.6%) and 53 (18.3%) biopsies had minor and major diagnostic discrepancies, respectively. The results showed that the overall agreement was significantly higher in cases with complete clinical information than patients without any clinical information and even with partial clinical information (P<0.001). Interestingly, no significant difference in inter-observer agreement was achieved with a length over 20 mm (P=0.181). However, the inter-observer variation significantly decreased when the number of portal tract was more than 10 (P=0.001). Conclusion: This study identified the impact of clinical information and the number of portal tracts as the key factors to diagnosis. Therefore, request forms for liver biopsies should always be accompanied with the clinical history. Moreover, adequacy of biopsy specimens is very useful for accurate evaluation of samples by pathologists.
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Affiliation(s)
- Zeinab Kishanifarahani
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mahsa Ahadi
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Behrang Kazeminejad
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Tahmineh Mollasharifi
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Amir Sadeghi
- Research Center for Gastroenterology and Liver Diseases, Taleghani Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Farahnaz Bidari
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Elena Jamali
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Niki Hasanzadeh
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Abolfazl Movafagh
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Arash Dehghan
- Pathology Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arsham Moradi
- University of Toronto, Department of Biology, Toronto, Canada
| | - Afshin Moradi
- Cancer Research Center, Shohada-e-Tajrish Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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SHG/TPEF-based image technology improves liver fibrosis assessment of minimally sized needle biopsies. Hepatol Int 2019; 13:501-509. [PMID: 31187402 PMCID: PMC6661026 DOI: 10.1007/s12072-019-09955-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/18/2019] [Indexed: 12/11/2022]
Abstract
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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Hwang M, Piskunowicz M, Darge K. Advanced Ultrasound Techniques for Pediatric Imaging. Pediatrics 2019; 143:e20182609. [PMID: 30808770 PMCID: PMC6398363 DOI: 10.1542/peds.2018-2609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Ultrasound has become a useful tool in the workup of pediatric patients because of the highly convenient, cost-effective, and safe nature of the examination. With rapid advancements in anatomic and functional ultrasound techniques over the recent years, the diagnostic and interventional utility of ultrasound has risen tremendously. Advanced ultrasound techniques constitute a suite of new technologies that employ microbubbles to provide contrast and enhance flow visualization, elastography to measure tissue stiffness, ultrafast Doppler to deliver high spatiotemporal resolution of flow, three- and four-dimensional technique to generate accurate spatiotemporal representation of anatomy, and high-frequency imaging to delineate anatomic structures at a resolution down to 30 μm. Application of these techniques can enhance the diagnosis of organ injury, viable tumor, and vascular pathologies at bedside. This has significant clinical implications in pediatric patients who are not easy candidates for lengthy MRI or radiation-requiring examination, and are also in need of a highly sensitive bedside technique for therapeutic guidance. To best use the currently available, advanced ultrasound techniques for pediatric patients, it is necessary to understand the diagnostic utility of each technique. In this review, we will educate the readers of emerging ultrasound techniques and their respective clinical applications.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Maciej Piskunowicz
- Department of Radiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
- Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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22
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Abstract
PURPOSE OF REVIEW EUS-guided liver biopsy (EUS-LB) is being used with increased frequency to perform parenchymal liver biopsy. Evolution of the technique can now achieve excellent liver tissue cores. This review covers important developments in this procedure. RECENT FINDINGS Clinical studies have recently demonstrated that the 19G EUS core biopsy needle is superior to non-core needles for liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time after the EUS-LB is sufficient in almost all cases. The EUS-LB can deliver bilobar biopsies, which can decrease sampling error. Patients who need a liver biopsy in addition to an endoscopy or EUS are best served by the EUS-LB, as the combination procedure saves time and cost. The EUS-LB is a safe and effective means for procuring good liver core biopsies. Incremental improvements in technique have increased quality of the resulting specimen. Future directions of this technique are discussed.
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Affiliation(s)
- Shaffer R S Mok
- Case Western Reserve University-School of Medicine, Cleveland, OH, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N. Academy Ave, 21-11, Danville, PA, 17822, USA.
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Xu B, Zhou NM, Cao WT, Li XJ. Evaluation of elastography combined with serological indexes for hepatic fibrosis in patients with chronic hepatitis B. World J Gastroenterol 2018; 24:4272-4280. [PMID: 30310260 PMCID: PMC6175765 DOI: 10.3748/wjg.v24.i37.4272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the value of ultrasound elastography combined with serological indexes in diagnosing liver fibrosis and assessing its severity.
METHODS A total of 338 chronic hepatitis B (CHB) patients were divided into a disease group (patients with hepatic fibrosis) and control group (subjects without hepatic fibrosis). The disease group was further divided into S1-S4 according to the degree of fibrosis. Independent risk factors for hepatic fibrosis were analyzed using multivariate logistic regression. The diagnostic values of hepatic fibrosis from different indicators were compared using receiver operating characteristic (ROC) curves. The combination of elastography and serological indexes was explored to assess the severity of hepatic fibrosis.
RESULTS The multivariate logistic regression analysis results revealed that shear wave velocity (SWV), hyaluronic acid (HA), type IV collagen (CIV) and aspartate aminotransferase-to-platelet ratio index (APRI) significantly affected the occurrence of hepatic fibrosis. The ROC curve revealed that the accuracy of the diagnosis of hepatic fibrosis for SWV and HA were 87.3% and 84.8%, respectively. The accuracy of SWV combined with HA was 88.9%. The multiple linear regression analysis revealed that SWV, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), HA, CIV, APRI and fibrosis index based on the 4 factor (FIB-4) were screened as statistically significant independent factors. The established regression equation was: Fibrosis level = -4.046 + 1.024 × SWV + 1.170 × AST/ALT + 0.011 × HA + 0.020 × CIV + 0.719 × APRI + 0.379 × FIB-4.
CONCLUSION SWV combined with serological indexes can improve the accuracy of diagnosis for CHB hepatic fibrosis. Serum indexes can help diagnose the degree of hepatic fibrosis.
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Affiliation(s)
- Bin Xu
- Department of ultrasound, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
| | - Ning-Ming Zhou
- Department of ultrasound, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
| | - Wei-Tian Cao
- Department of ultrasound, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
| | - Xiao-Jing Li
- Department of pathology, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
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Shirabe K, Bekki Y, Gantumur D, Araki K, Ishii N, Kuno A, Narimatsu H, Mizokami M. Mac-2 binding protein glycan isomer (M2BPGi) is a new serum biomarker for assessing liver fibrosis: more than a biomarker of liver fibrosis. J Gastroenterol 2018; 53:819-826. [PMID: 29318378 DOI: 10.1007/s00535-017-1425-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/18/2017] [Indexed: 02/04/2023]
Abstract
Assessing liver fibrosis is important for predicting the efficacy of antiviral therapy and patient prognosis. Liver biopsy is the gold standard for diagnosing liver fibrosis, despite its invasiveness and problematic diagnostic accuracy. Although noninvasive techniques to assess liver fibrosis are becoming important, reliable serum surrogate markers are not available. A glycoproteomics study aimed at identifying such markers discovered Mac 2-Binding Protein Gylcan Isomer (M2BPGi), which is a reliable marker for assessing liver fibrosis in patients with viral hepatitis and other fibrotic liver diseases such as primary biliary cholangitis, biliary atresia, autoimmune hepatitis, and nonalcoholic fatty liver disease. M2BPGi predicts the development of hepatocellular carcinoma (HCC) in patients infected with hepatitis B and C as well as the prognosis of liver cirrhosis in those with HCC after therapy. The unique features of M2BPGi are as follows: (1) cut-off values differ for the same stages of fibrosis according to the cause of fibrosis; and (2) M2BPGi levels rapidly decrease after patients achieve a sustained antiviral response to hepatitis C virus. These observations cannot be explained if M2BPGi levels reflect the amount of fibrotic tissue. Hepatic stellate cells (HSCs) secrete M2BPGi, which may serve as a messenger between HSCs and Kupffer cells via Mac-2 (galectin 3) that is expressed in Kupffer cells during fibrosis progression. Here we show that M2BPGi is a surrogate marker for assessing HSC activation. These findings may reveal the roles of HSCs in extrahepatic fibrotic disease progression.
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Affiliation(s)
- Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, 3-39-22 Showa Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Yuki Bekki
- Department of Surgery and Science, Kyushu University, Graduate School of Medicine, Fukuoka, Fukuoka, Japan
| | - Dolgormaa Gantumur
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, 3-39-22 Showa Machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, 3-39-22 Showa Machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, 3-39-22 Showa Machi, Maebashi, Gunma, 371-8511, Japan
| | - Atsushi Kuno
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan
| | - Hisashi Narimatsu
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan
| | - Masashi Mizokami
- Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
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Mendes LC, Stucchi RS, Vigani AG. Diagnosis and staging of fibrosis in patients with chronic hepatitis C: comparison and critical overview of current strategies. Hepat Med 2018; 10:13-22. [PMID: 29662329 PMCID: PMC5892613 DOI: 10.2147/hmer.s125234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the past years, what has always been considered undisputed true in liver fibrosis staging has been challenged. Diagnostic performance of histological evaluation has proven to be significantly influenced by sample- and observer-related variabilities. Differentiation between lower levels of fibrosis remains difficult for many, if not all, test modalities, including liver biopsy but, perhaps, such a distinction is not indispensable in light of current therapeutic approaches. Biomarkers and elastography offer, nonetheless, high predictive values for advanced fibrosis and cirrhosis and correlate well with liver-related outcomes. Necroinflammation, steatosis, and hemodynamic changes may significantly interfere with elastography-based techniques, and longitudinal follow-up strategies must be tailored in light of these findings. Knowledge of different test modalities and diagnostic performance indicators can allow for better clinical decision-making and resource allocation.
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Affiliation(s)
- Leandro César Mendes
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - Raquel Sb Stucchi
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - Aline G Vigani
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
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Eulenberg VM, Lidbury JA. Hepatic Fibrosis in Dogs. J Vet Intern Med 2017; 32:26-41. [PMID: 29194760 PMCID: PMC5787209 DOI: 10.1111/jvim.14891] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022] Open
Abstract
Hepatic fibrosis is commonly diagnosed in dogs, often as a sequela to chronic hepatitis (CH). The development of fibrosis is a crucial event in the progression of hepatic disease that is of prognostic value. The pathophysiology of hepatic fibrosis in human patients and rodent models has been studied extensively. Although less is known about this process in dogs, evidence suggests that fibrogenic mechanisms are similar between species and that activation of hepatic stellate cells is a key step. Diagnosis and staging of hepatic fibrosis in dogs requires histopathological examination of a liver biopsy specimen. However, performing a liver biopsy is invasive and assessment of fibrotic stage is complicated by the absence of a universally accepted staging scheme in veterinary medicine. Serum biomarkers that can discriminate among different fibrosis stages are used in human patients, but such markers must be more completely evaluated in dogs before clinical use. When successful treatment of its underlying cause is feasible, reversal of hepatic fibrosis has been shown to be possible in rodent models and human patients. Reversal of fibrosis has not been well documented in dogs, but successful treatment of CH is possible. In human medicine, better understanding of the pathomechanisms of hepatic fibrosis is leading to the development of novel treatment strategies. In time, these may be applied to dogs. This article comparatively reviews the pathogenesis of hepatic fibrosis, its diagnosis, and its treatment in dogs.
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Affiliation(s)
- V M Eulenberg
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
| | - J A Lidbury
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
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Mancini M, Salomone Megna A, Ragucci M, De Luca M, Marino Marsilia G, Nardone G, Coccoli P, Prinster A, Mannelli L, Vergara E, Monti S, Liuzzi R, Incoronato M. Reproducibility of shear wave elastography (SWE) in patients with chronic liver disease. PLoS One 2017; 12:e0185391. [PMID: 29023554 PMCID: PMC5638246 DOI: 10.1371/journal.pone.0185391] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/12/2017] [Indexed: 02/06/2023] Open
Abstract
The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14-16.7 kPa and were 4.49 kPa and 2.92-7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with inflammatory activity (Rs = 0.443, p = 0.0023) and ALT levels (Rs = 0.287, p = 0.0804). Age, sex and body mass index did not affect shear wave elastography measurements. Using receiver operator characteristic curves, two threshold values for shear wave elastography were identified: 5.62 kPa for patients with fibrosis (≥F2; sensitivity 80%, specificity 69.4%, and accuracy 77%) and 7.04 kPa for patients with severe fibrosis (≥F3; sensitivity 88.9%, specificity 81%, and accuracy 89%). Overall interobserver agreement was excellent and was analysed using an interclass correlation coefficient (0.94; CI 0.87-0.97).This study shows that shear wave elastography executed by skilled operators can be performed on almost all chronic liver disease patients with high reproducibility. It is not influenced by age, sex or body mass index, identifies severely fibrotic patients and is also related to inflammatory activity.
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Affiliation(s)
- Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | | | - Monica Ragucci
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | | | | | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University, Naples, Italy
| | - Pietro Coccoli
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University, Naples, Italy
| | - Anna Prinster
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, United States of America
| | - Emilia Vergara
- Istituto di Ricovero e Cura a Carattere Scientifico SDN (IRCCS SDN), Naples, Italy
- Dipartimento Assistenziale Integrato di Diagnostica morfologica e funzionale, Radioterapia, Medicina Legale, A.O.U. Federico II, Naples, Italy
| | - Serena Monti
- Istituto di Ricovero e Cura a Carattere Scientifico SDN (IRCCS SDN), Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
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Comparison of the Diagnostic Yield of EUS Needles for Liver Biopsy: Ex Vivo Study. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2017; 2017:1497831. [PMID: 29056843 PMCID: PMC5615982 DOI: 10.1155/2017/1497831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/13/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS EUS-guided liver biopsy is an emerging method of liver tissue acquisition which is safe and had been shown to produce excellent histological yield. There is limited data comparing the diagnostic yield of different FNA needles. We aimed to compare the diagnostic performance of four commercially available 19-gauge FNA needles. METHODS Four FNA needles and one percutaneous needle were used to perform liver biopsies on two human cadaveric livers: Cook Echotip Procore™, Olympus EZ Shot 2™, Boston Scientific Expect Slimline™, Covidien SharkCore™, and an 18-gauge percutaneous needle (TruCore™, Argon Medical Devices). Each needle obtained biopsies by three, six, and nine complete back-and-forth motions of the needle ("throw") with a fanning technique. The combined lengths of specimen fragments and the total number of complete portal tracts (CPT) were measured by a blinded pathologist. One-way analysis of variance (ANOVA) and Bonferroni correction were used for statistical analysis. RESULTS A total of 52 liver biopsies were performed. The Covidien SharkCore needle had significantly greater number of CPT compared to other FNA needles. The number of "throws" did not impact the number of CPT significantly. There was no statistically significant difference in mean total specimen length between each FNA needle type. CONCLUSION The Covidien SharkCore needle produced superior histological specimen by capturing more CPT, possibly due to its unique needle design.
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29
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Shiha G, Seif S, Eldesoky A, Elbasiony M, Soliman R, Metwally A, Zalata K, Mikhail N. A simple bedside blood test (Fibrofast; FIB-5) is superior to FIB-4 index for the differentiation between non-significant and significant fibrosis in patients with chronic hepatitis C. Hepatol Int 2017; 11:286-291. [PMID: 28425016 DOI: 10.1007/s12072-017-9796-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 03/30/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION A simple non-invasive score (Fibrofast, FIB-5) was developed using five routine laboratory tests (ALT, AST, alkaline phosphatase, albumin and platelets count) for the detection of significant hepatic fibrosis in patients with chronic hepatitis C. The FIB-4 index is a non-invasive test for the assessment of liver fibrosis, and a score of ≤1.45 enables the correct identification of patients who have non-significant (F0-1) from significant fibrosis (F2-4), and could avoid liver biopsy. The aim of this study was to compare the performance characteristics of FIB-5 and FIB-4 to differentiate between non-significant and significant fibrosis. METHOD A cross-sectional study included 604 chronic HCV patients. All liver biopsies were scored using the METAVIR system. Both FIB-5 and FIB-4 scores were measured and the performance characteristics were calculated using the ROC curve. RESULTS The performance characteristics of FIB-5 at ≥7.5 and FIB-4 at ≤1.45 for the differentiation between non-significant fibrosis and significant fibrosis were: specificity 94.4%, PPV 85.7%, and specificity 54.9%, PPV 55.7% respectively. CONCLUSION FIB-5 score at the new cutoff is superior to FIB-4 index for the differentiation between non-significant and significant fibrosis.
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Affiliation(s)
- G Shiha
- Gastrohepatology Unit, Internal Medicine Department, Faculty of Medicine, Specialized Medical Hospital, Mansoura University, Mansoura, Egypt.
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
| | - S Seif
- Gastrohepatology Unit, Internal Medicine Department, Faculty of Medicine, Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - A Eldesoky
- Gastrohepatology Unit, Internal Medicine Department, Faculty of Medicine, Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - M Elbasiony
- Gastrohepatology Unit, Internal Medicine Department, Faculty of Medicine, Specialized Medical Hospital, Mansoura University, Mansoura, Egypt
| | - R Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - A Metwally
- Community Medicine Department, National Research Center, Cairo, Egypt
| | - K Zalata
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - N Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
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30
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Engelmann G, Quader J, Teufel U, Schenk JP. Limitations and opportunities of non-invasive liver stiffness measurement in children. World J Hepatol 2017; 9:409-417. [PMID: 28357028 PMCID: PMC5355763 DOI: 10.4254/wjh.v9.i8.409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Changes in liver structure are an important issue in chronic hepatopathies. Until the end of the 20th century, these changes could only be determined by histological analyses of a liver specimen obtained via biopsy. The well-known limitations of this technique (i.e., pain, bleeding and the need for sedation) have precluded its routine use in follow-up of patients with liver diseases. However, the introduction of non-invasive technologies, such as ultrasound and magnetic resonance imaging, for measurement of liver stiffness as an indirect marker of fibroses has changed this situation. Today, several non-invasive tools are available to physicians to estimate the degree of liver fibrosis by analysing liver stiffness. This review describes the currently available tools for liver stiffness determination that are applicable to follow-up of liver fibrosis/cirrhosis with established clinical use in children, and discusses their features in comparison to the “historical” tools.
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Abstract
Treatment with direct-acting antiviral agents has revolutionized the approach to hepatitis C. We are now able to obtain high sustained virological response (SVR) rates, even in the historically difficult-to-treat patient populations. SVR translates into improved clinical outcomes, particularly overall and liver-related mortality, and benefits are more striking in patients with cirrhosis. A 2.5- to 5-fold risk reduction in the incidence of hepatocellular carcinoma and improvement in complications derived from portal hypertension have been reported as well. It is hypothesized that the benefits from SVR occur largely due to regression of fibrosis, which arises from the halt on the fibrogenic stimuli and activation of extracellular matrix reabsorption signals. Non-invasive markers of fibrosis are being utilized to assess regression, but it is still unclear how accurate they are in this clinical scenario. Interventions aiming to improve liver wellness and screening for cirrhosis-related complications should continue to be the norm after SVR.
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Shiha G, Ibrahim A, Helmy A, Sarin SK, Omata M, Kumar A, Bernstien D, Maruyama H, Saraswat V, Chawla Y, Hamid S, Abbas Z, Bedossa P, Sakhuja P, Elmahatab M, Lim SG, Lesmana L, Sollano J, Jia JD, Abbas B, Omar A, Sharma B, Payawal D, Abdallah A, Serwah A, Hamed A, Elsayed A, AbdelMaqsod A, Hassanein T, Ihab A, GHaziuan H, Zein N, Kumar M. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int 2017; 11:1-30. [PMID: 27714681 DOI: 10.1007/s12072-016-9760-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/13/2016] [Indexed: 12/14/2022]
Abstract
Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated. The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The first consensus guidelines of the APASL recommendations on hepatic fibrosis were published in 2009. Due to advances in the field, we present herein the APASL 2016 updated version on invasive and non-invasive assessment of hepatic fibrosis. The process for the development of these consensus guidelines involved review of all available published literature by a core group of experts who subsequently proposed consensus statements followed by discussion of the contentious issues and unanimous approval of the consensus statements. The Oxford System of the evidence-based approach was adopted for developing the consensus statements using the level of evidence from one (highest) to five (lowest) and grade of recommendation from A (strongest) to D (weakest). The topics covered in the guidelines include invasive methods (LB and hepatic venous pressure gradient measurements), blood tests, conventional radiological methods, elastography techniques and cost-effectiveness of hepatic fibrosis assessment methods, in addition to fibrosis assessment in special and rare situations.
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Affiliation(s)
- Gamal Shiha
- Internal Medicine Department, El-Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt.
| | - Alaa Ibrahim
- Department of Internal medicine, University of Benha, Benha, Egypt
| | - Ahmed Helmy
- Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Masao Omata
- Department of Gastroenterology, University of Tokyo, Tokyo, Japan
| | - Ashish Kumar
- Department of Gastroenterology & Hepatology, Ganga Ram Institute for Postgraduate Medical Education & Research of Sir Ganga Ram Hospital, New Delhi, India
| | - David Bernstien
- Division of Hepatology, North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Hitushi Maruyama
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Chiba Prefecture, Japan
| | - Vivek Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yogesh Chawla
- Post Graduate Institute of Medial Education & Research, Chandigarh, India
| | - Saeed Hamid
- Department of Medicine, The Aga Khan University & Hospital, Stadium Road, Karachi, Pakistan
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Pierre Bedossa
- Department of Pathology, Physiology and Imaging, University Paris Diderot, Paris, France
| | - Puja Sakhuja
- Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Mamun Elmahatab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Jose Sollano
- University of Santo Tomas, España Blvd, Manila, Philippines
| | - Ji-Dong Jia
- Liver Research Centre at the Beijing Friendship Hospital, Capital University in Beijing, Beijing, China
| | - Bahaa Abbas
- Department of Internal Medicine, Military Medical Academy, Cairo, Egypt
| | - Ashraf Omar
- Tropical Medicine Department, Cairo Medical School, Cairo, Egypt
| | - Barjesh Sharma
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Diana Payawal
- Section of Gastroenterology, Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines
| | - Ahmed Abdallah
- Pediatric Hospital, Mansoura University, Mansoura, Egypt
| | | | - Abdelkhalek Hamed
- Hepatology and Diabetes Unit, Military Medical Academy, Cairo, Egypt
| | - Aly Elsayed
- Hepatology & GIT Department, AHF Center Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Amany AbdelMaqsod
- Internal Medicine Department, Faculty of Medicine Cairo University, Liver Transplant Unit Manial Hospital and Liver ICU French Hospital, Cairo University, Cairo, Egypt
| | | | - Ahmed Ihab
- Molecular Pathology Unit & Research Group, German University in Cairo, Cairo, Egypt
| | - Hamsik GHaziuan
- Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
| | - Nizar Zein
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, USA
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
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Srinivasa Babu A, Wells ML, Teytelboym OM, Mackey JE, Miller FH, Yeh BM, Ehman RL, Venkatesh SK. Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions. Radiographics 2016; 36:1987-2006. [PMID: 27689833 PMCID: PMC5584553 DOI: 10.1148/rg.2016160042] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/16/2016] [Accepted: 07/27/2016] [Indexed: 12/12/2022]
Abstract
Chronic liver disease has multiple causes, many of which are increasing in prevalence. The final common pathway of chronic liver disease is tissue destruction and attempted regeneration, a pathway that triggers fibrosis and eventual cirrhosis. Assessment of fibrosis is important not only for diagnosis but also for management, prognostic evaluation, and follow-up of patients with chronic liver disease. Although liver biopsy has traditionally been considered the reference standard for assessment of liver fibrosis, noninvasive techniques are the emerging focus in this field. Ultrasound-based elastography and magnetic resonance (MR) elastography are gaining popularity as the modalities of choice for quantifying hepatic fibrosis. These techniques have been proven superior to conventional cross-sectional imaging for evaluation of fibrosis, especially in the precirrhotic stages. Moreover, elastography has added utility in the follow-up of previously diagnosed fibrosis, the assessment of treatment response, evaluation for the presence of portal hypertension (spleen elastography), and evaluation of patients with unexplained portal hypertension. In this article, a brief overview is provided of chronic liver disease and the tools used for its diagnosis. Ultrasound-based elastography and MR elastography are explored in depth, including a brief glimpse into the evolution of elastography. Elastography is based on the principle of measuring tissue response to a known mechanical stimulus. Specific elastographic techniques used to exploit this principle include MR elastography and ultrasonography-based static or quasistatic strain imaging, one-dimensional transient elastography, point shear-wave elastography, and supersonic shear-wave elastography. The advantages, limitations, and pitfalls of each modality are emphasized. ©RSNA, 2016.
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Affiliation(s)
- Aparna Srinivasa Babu
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Michael L. Wells
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Oleg M. Teytelboym
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Justin E. Mackey
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Frank H. Miller
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Benjamin M. Yeh
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Richard L. Ehman
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Sudhakar K. Venkatesh
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California–San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
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Lee HW, Park SY, Kim SU, Jang JY, Park H, Kim JK, Lee CK, Chon YE, Han KH. Discrimination of Nonalcoholic Steatohepatitis Using Transient Elastography in Patients with Nonalcoholic Fatty Liver Disease. PLoS One 2016; 11:e0157358. [PMID: 27284700 PMCID: PMC4902201 DOI: 10.1371/journal.pone.0157358] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS The accuracy of noninvasive markers to discriminate nonalcoholic steatohepatitis (NASH) is unsatisfactory. We investigated whether transient elastography (TE) could discriminate patients with NASH from those with nonalcoholic fatty liver disease (NAFLD). METHODS The patients suspected of NAFLD who underwent liver biopsy and concomitant TE were recruited from five tertiary centers between November 2011 and December 2013. RESULTS The study population (n = 183) exhibited a mean age of 40.6 years and male predominance (n = 111, 60.7%). Of the study participants, 89 (48.6%) had non-NASH and 94 (51.4%) had NASH. The controlled attenuation parameter (CAP) and liver stiffness (LS) were significantly correlated with the degrees of steatosis (r = 0.656, P<0.001) and fibrosis (r = 0.714, P<0.001), respectively. The optimal cut-off values for steatosis were 247 dB/m for S1, 280 dB/m for S2, and 300 dB/m for S3. Based on the independent predictors derived from multivariate analysis [P = 0.044, odds ratio (OR) 4.133, 95% confidence interval (CI) 1.037-16.470 for CAP>250 dB/m; P = 0.013, OR 3.399, 95% CI 1.295-8.291 for LS>7.0 kPa; and P<0.001, OR 7.557, 95% CI 2.997-19.059 for Alanine aminotransferase>60 IU/L], we developed a novel CLA model for discriminating patients with NASH. The CLA model showed good discriminatory capability, with an area under the receiver operating characteristic curve (AUROC) of 0.812 (95% CI 0.724-0.880). To assess discriminatory power, the AUROCs, as determined by the bootstrap method, remained largely unchanged between iterations, with an average value of 0.833 (95% CI 0.740-0.893). CONCLUSION This novel TE-based CLA model showed acceptable accuracy in discriminating NASH from simple steatosis. However, further studies are required for external validation.
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Affiliation(s)
- Hye Won Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hana Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Bundang, Korea
| | - Ja Kyung Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Chun Kyon Lee
- National Health Insurance Cooperation, Ilsan Hospital, Ilsan, Korea
| | - Young Eun Chon
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Li C, Zhang C, Li J, Huo H, Song D. Diagnostic Accuracy of Real-Time Shear Wave Elastography for Staging of Liver Fibrosis: A Meta-Analysis. Med Sci Monit 2016; 22:1349-59. [PMID: 27102449 PMCID: PMC4844274 DOI: 10.12659/msm.895662] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The present meta-analysis, based on previous studies, was aimed to evaluate the test accuracy of real-time shear wave elastography (SWE) for the staging of liver fibrosis. MATERIAL AND METHODS A systematic search on MEDLINE, PubMed, Embase, and Google Scholar databases was conducted, and data on SWE tests and liver fibrosis staging were collected. For each cut-off stage of fibrosis (F≥2, F≥3, and F≥4), pooled results of sensitivity, specificity, and area under summary receiver operating characteristic (SROC) curve were analyzed. The study heterogeneity was evaluated by χ2 and I2 tests. I2>50% or P≤0.05 indicates there was heterogeneity, and then a random-effects model was applied. Otherwise, the fixed-effects model was used. The publication bias was evaluated using Deeks funnel plots asymmetry test and Fagan plot analysis was performed. RESULTS Finally, 934 patients from 8 published studies were included in the analysis. The pooled sensitivity and specificity of SWE for F≥2 were 85.0% (95% CI, 82-88%) and 81% (95% CI, 71-88%), respectively. The area under the SROC curve with 95% CI was presented as 0.88 (95% CI, 85-91%). The pooled sensitivity and specificity of SWE for F≥3 were 90.0% (95% CI, 83.0-95.0%) and 81.0% (95% CI, 75.0-86.0%), respectively, corresponding to an area of SROC of 0.94 (95% CI, 92-96%). The pooled sensitivity and specificity of SWE for F≥4 were 87.0% (95% CI, 80.0-92.0%) and 88.0% (95% CI, 80.0-93.0%), respectively, corresponding to an area of SROC of 0.92 (95% CI, 89-94%). CONCLUSIONS The overall accuracy of SWE is high and clinically useful for the staging of liver fibrosis. Compared to the results of meta-analyses on other tests, such as RTE, TE, and ARFI, the performance of SWE is nearly identical in accuracy for the evaluation of cirrhosis. For the evaluation of significant liver fibrosis (F≥2), the overall accuracy of SWE seems to be similar to ARFI, but more accurate than RTE and TE.
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Affiliation(s)
- Changtian Li
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Changsheng Zhang
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Junlai Li
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Huiping Huo
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Danfei Song
- Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
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Coral GP, Antunes ADP, Serafini APA, Araujo FB, Mattos AAD. LIVER BIOPSY: IMPORTANCE OF SPECIMEN SIZE IN THE DIAGNOSIS AND STAGING OF CHRONIC VIRAL HEPATITIS. Rev Inst Med Trop Sao Paulo 2016; 58:10. [PMID: 26910447 PMCID: PMC4793951 DOI: 10.1590/s1678-9946201658010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/19/2015] [Indexed: 12/24/2022] Open
Abstract
Liver biopsy is the gold standard method for the grading and staging of chronic viral
hepatitis, but optimal biopsy specimen size remains controversial. The aim of this
study was to evaluate the quality of liver specimen (number of portal tracts) and to
evaluate the impact of the number of portal tracts in the staging of chronic
hepatitis.
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Affiliation(s)
- Gabriela P Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis. Eur Radiol 2015; 25:3214-21. [PMID: 25903706 DOI: 10.1007/s00330-015-3728-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/15/2015] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH). MATERIALS AND METHODS Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria. RESULTS Of 123 patients, LS was successfully measured in 79.7% and SS in 53.7%. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index. CONCLUSIONS RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC. KEY POINTS • RT 2D-SWE is an accurate method for assessment of liver fibrosis. • RT 2D-SWE is applicable in 80% of patients with chronic viral hepatitis. • RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. • Both liver and spleen stiffness increase with progression of liver fibrosis. • In cirrhosis, the difference between liver and spleen stiffness decreases.
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Schwarzer, R, Ferlitsch, A. Liver Biopsy-Transjugular. Clin Liver Dis (Hoboken) 2014; 4:113-115. [PMID: 30992935 PMCID: PMC6448748 DOI: 10.1002/cld.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/17/2014] [Accepted: 10/01/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rémy Schwarzer,
- Department of Internal Medicine III, Division of Gastroenterology and HepatologyMedical University of ViennaViennaAustria
| | - Arnulf Ferlitsch,
- Department of Internal Medicine III, Division of Gastroenterology and HepatologyMedical University of ViennaViennaAustria
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Kobayashi K, Nakao H, Nishiyama T, Lin Y, Kikuchi S, Kobayashi Y, Yamamoto T, Ishii N, Ohashi T, Satoh K, Nakade Y, Ito K, Yoneda M. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis: a meta-analysis. Eur Radiol 2014; 25:230-8. [PMID: 25149296 DOI: 10.1007/s00330-014-3364-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/07/2014] [Accepted: 07/18/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis. METHODS We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger's test. RESULTS Summary sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.82 and 0.81 for F ≥ 3, and 0.74 and 0.84 for F ≥ 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p = 0.004 for F ≥ 2, p < 0.001 for F ≥ 3, and p = 0.002 for F ≥ 4). CONCLUSIONS RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis. KEY POINTS • Non-invasive methods for evaluating liver fibrosis are necessary to replace liver biopsy. • ARFI is as accurate as TE for evaluating liver fibrosis. • RTE may be as accurate as TE and ARFI for fibrosis. • RTE may be less accurate than TE and ARFI for cirrhosis. • The estimated accuracy of RTE may be overestimated by publication bias.
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Affiliation(s)
- Kunio Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Molla N, AlMenieir N, Simoneau E, Aljiffry M, Valenti D, Metrakos P, Boucher LM, Hassanain M. The role of interventional radiology in the management of hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 21:e480-92. [PMID: 24940108 DOI: 10.3747/co.21.1829] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (hcc) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced hcc or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications. METHODS A systemic search of PubMed, medline, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review. RESULTS Needle core biopsy is a highly sensitive, specific, and accurate method for hcc grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child-Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities-transarterial chemoembolization (tace), drug-eluting beads, and transarterial radio-embolization (tare)-tace is the method of choice in Child-Pugh A disease, and tare is the method of choice in hcc cases with portal vein thrombosis. CONCLUSIONS The existing data support the importance of a multidisciplinary approach in hcc management. Large randomized controlled studies are needed to provide clear indication guidelines for each method.
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Affiliation(s)
- N Molla
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia. ; Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - N AlMenieir
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - E Simoneau
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - M Aljiffry
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - L M Boucher
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - M Hassanain
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
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Consensus on the histopathological evaluation of liver biopsies from patients following allogeneic hematopoietic cell transplantation. Virchows Arch 2014; 464:175-90. [PMID: 24385287 DOI: 10.1007/s00428-013-1528-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/07/2013] [Accepted: 12/09/2013] [Indexed: 12/13/2022]
Abstract
After allogeneic hematopoietic cell transplantation (alloHCT) liver biopsy is performed for enigmatic liver disorders when noninvasive diagnostic steps have failed in establishing a definitive diagnosis. This document provides an updated consensus on the prerequisites for proper evaluation of liver biopsies in alloHCT patients and the histological diagnostic criteria for liver graft-versus-host disease (GvHD). The Working Group's recommendations for the histological diagnosis of liver GvHD were derived from the peer-reviewed literature and from the consensus diagnosis of a total of 30 coded liver biopsies. Acceptance of the recommendations was tested by a survey distributed to all HCT centers in Austria, Germany and Switzerland. Consensus was achieved for biopsy indications, methods of sample acquisition and processing, reporting and interpretation of biopsy findings. As GvHD is variably treated and the treatment modalities have changed over time, the panel endorses the use of more frequent biopsies in clinical studies in order to improve the present challenging clinical and diagnostic situation.
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Ki YJ, Ji SH, Min JS, Jin SH, Park S, Yu HJ, Bang HY, Lee JI. Test execution variation in peritoneal lavage cytology could be related to poor diagnostic accuracy and stage migration in patients with gastric cancer. J Gastric Cancer 2013; 13:214-25. [PMID: 24511417 PMCID: PMC3915183 DOI: 10.5230/jgc.2013.13.4.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Peritoneal lavage cytology is part of the routine staging workup for patients with advanced gastric cancer. However, no quality assurance study has been conducted to show variations or biases in peritoneal lavage cytology results. The aim of this study was to demonstrate a test execution variation in peritoneal lavage cytology between investigating surgeons. MATERIALS AND METHODS A prospective cohort study was designed for determination of the positive rate of peritoneal lavage cytology using a liquid-based preparation method in patients with potentially curable advanced gastric cancer (cT2~4/N0~2/M0). One hundred thirty patients were enrolled and underwent laparotomy, peritoneal lavage cytology, and standard gastrectomy, which were performed by 3 investigating surgeons. Data were analyzed using the chi-square test and a logistic regression model. RESULTS The overall positive peritoneal cytology rate was 10.0%. Subgroup positive rates were 5.3% in pT1 cancer, 2.0% in pT2/3 cancer, 11.1% in pT4a cancer, and 71.4% in pT4b cancer. In univariate analysis, positive peritoneal cytology showed significant correlation with pT stage, lymphatic invasion, vascular invasion, ascites, and the investigating surgeon. We found the positive rate to be 2.1% for surgeon A, 10.2% for surgeon B, and 20.6% for surgeon C (P=0.024). Multivariate analysis identified pT stage, ascites, and the investigating surgeon to be significant risk factors for positive peritoneal cytology. CONCLUSIONS The peritoneal lavage cytology results were significantly affected by the investigating surgeon, providing strong evidence of test execution variation that could be related to poor diagnostic accuracy and stage migration in patients with advanced gastric cancer.
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Affiliation(s)
- Young-Jun Ki
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sun-Hee Ji
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Jae Seok Min
- Department of Surgery, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Sung-Ho Jin
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sunhoo Park
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hang-Jong Yu
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Ho-Yoon Bang
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jong-Inn Lee
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Li N, Puga Yung GL, Pradier A, Toso C, Giostra E, Morard I, Spahr L, Seebach JD. NK cell isolation from liver biopsies: phenotypic and functional analysis of low cell numbers by flow cytometry. Front Immunol 2013; 4:61. [PMID: 23482713 PMCID: PMC3593626 DOI: 10.3389/fimmu.2013.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/22/2013] [Indexed: 12/29/2022] Open
Abstract
Natural killer (NK) cells are considered to play a critical role in liver disease. However, the available numbers of intrahepatic lymphocytes (IHL) derived from liver biopsies (LB) for ex vivo analysis of intrahepatic NK cells is very limited; and the isolation method may hamper not only yields and viability, but also phenotype and function of IHL. The aim of the present study was therefore to (1) refine and evaluate the cell yields and viability of a modified isolation protocol from standard size needle LB; and (2) to test the effects of mechanical dissociation and enzymatic tissue digestion, as well as the analysis of very low cell numbers, on the phenotype and function of intrahepatic NK cells. Peripheral blood mononuclear cells (PBMC) and IHL, freshly isolated from the peripheral blood, LB (n = 11) or partial liver resections (n = 5), were used for phenotypic analysis by flow cytometry. NK cell function, i.e., degranulation and cytokine production, was determined by staining of CD107a and intracellular IFN-γ following in vitro stimulation. The mean weight of the LB specimens was 9.1 mg, and a mean number of 7,364 IHL/mg were obtained with a viability of >90%. Exposure of IHL and PBMC to 0.5 mg/ml collagenase IV and 0.02 mg/ml DNase I for 30 min did affect neither the viability, NK cell function, nor the percentages of CD56+, NKp46+, and CD16+ NK cells, whereas the level of CD56 surface expression was reduced. The phenotype of LB-derived NK cells was reliably characterized by acquiring as few as 2,500 IHL per tube for flow cytometry. The functional assay of intrahepatic NK cells was miniaturized by culturing as few as 25,000 IHL in 25 μl (106/ml) using 96-well V-bottom plates with IL-2 and IL-12 overnight, followed by a 4 h stimulation with K562 cells at a NK:K562 ratio of 1:1. In summary, we report reliable phenotypic and functional analyses of small numbers of intrahepatic NK cells isolated from LB specimens providing us with a tool to better address the emerging role of human NK cell immunobiology in liver diseases.
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Affiliation(s)
- Ning Li
- Division of Clinical Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty Geneva, Switzerland
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Samiullah S, Bikharam D, Nasreen. Treatment of chronic hepatitis delta virus with peg-interferon and factors that predict sustained viral response. World J Gastroenterol 2012; 18:5793-8. [PMID: 23155322 PMCID: PMC3484350 DOI: 10.3748/wjg.v18.i40.5793] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 07/27/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the efficacy of peg-interferon in the treatment of hepatitis delta virus (HDV) and to identify the factors that would be predictive of the sustained viral response (SVR).
METHODS: This prospective study was conducted in Medical Unit IV of the Liaquat University of Medical and Health Sciences Hospital Jamshoro from June 2008 to September 2011. This study cohort included all patients of either sex who presented during this time with hepatitis B surface antigen positivity, hepatitis B virus DNA > 20 000 IU/mL, serum glutamic pyruvic transaminase (SGPT) > 2(upper limit of normal), HDV-RNA positivity with fibrosis stage ≥ 2. Informed consent was obtained from each of these individuals. Patients were diagnosed with hepatitis D on the basis of detectable viral antibodies and the presence of HDV-RNA in their serum. A liver biopsy was performed in all cases and fibrosis staging was performed in accordance with the METAVIR scoring system. All eligible patients were administered peg-interferon at a weekly dosage of 1.5 μg/kg body weight for 48 wk. HDV-RNA was assayed at the end of this treatment period and again at 24 wk later. A biochemical response was determined by a normalization of SGPT at the end of the treatment or during follow up. The end of treatment response was defined by a HDV-RNA negative status. A sustained virological response was defined by undetectable serum HDV-RNA at six months after the end of treatment.
RESULTS: Among the 277 patients enrolled in our present study, 238 completed a course of peg-interferon therapy of which 180 (75.6%) were male and 58 (24.4%) female. Biochemical responses were achieved in 122/238 (51.3%) patients. End of treatment responses were achieved in 71/238 (29.8%) cases. A SVR was achieved in 70 of these patients (29.4%). A strong association was found between the SVR and the end of treatment responses (P = 0.001), biochemical responses (P = 0.001) and the degree of fibrosis (P = 0.002).
CONCLUSION: Peg-interferon therapy can induce remission in nearly one third of patients harboring HDV.
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Farrington EA, Maskell G, Hussaini HS. Feasibility and experience of nurse-led ultrasound-guided percutaneous liver biopsy. Frontline Gastroenterol 2012; 3:187-190. [PMID: 28839662 PMCID: PMC5517286 DOI: 10.1136/flgastro-2012-100154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 03/14/2012] [Indexed: 02/04/2023] Open
Abstract
The demand for collaborative and innovative clinical practitioners to act as leaders in healthcare remains strong as many challenges are faced including rising costs, shortage of professionals, the introduction of new technology and difficulties with access to care. Nurses in advanced nursing practice are well positioned to respond to this, playing a key role in building nursing knowledge, advancing the nursing profession and contributing to sustainable and effective healthcare systems. Percutaneous liver biopsy (PLB) is an essential tool used for diagnosis and management in liver disease, being most commonly performed by consultant gastroenterologists, hepatologists and radiologists. While invasive and with complications PLB is a simple, cost-effective procedure that can be undertaken at the bedside. Our study demonstrates that an advanced nurse practitioner (ANP) with a sound working knowledge of hepatology and familiarity with indications, methods and risks of PLB procedure can be trained to perform ultrasound-guided liver biopsy both safely and effectively.
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Affiliation(s)
| | - Giles Maskell
- Department of Radiology, Royal Cornwall Hospital, Truro, UK
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Abstract
Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adipose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal tumor in a 51-year-old male with anemia, weight loss and hepatomegaly. Finally unconventional liver biopsy and histological manifestation led to the definitive diagnosis.
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Gheonea DI, Săftoiu A, Ciurea T, Gorunescu F, Iordache S, Popescu GL, Belciug S, Gorunescu M, Săndulescu L. Real-time sono-elastography in the diagnosis of diffuse liver diseases. World J Gastroenterol 2010; 16:1720-6. [PMID: 20380003 PMCID: PMC2852819 DOI: 10.3748/wjg.v16.i14.1720] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze whether computer-enhanced dynamic analysis of elastography movies is able to better characterize and differentiate between different degrees of liver fibrosis.
METHODS: The study design was prospective. A total of 132 consecutive patients with chronic liver diseases and healthy volunteers were examined by transabdominal ultrasound elastography. All examinations were done by two doctors.
RESULTS: Due to the limitations of the method, we obtained high-quality elastography information in only 73.48% of the patients. The κ-means clustering method was applied to assess the inter-observer diagnosis variability, which showed good variability values in accordance with the experience of ultrasound examination of every observer. Cohen’s κ test indicated a moderate agreement between the study observers (κ = 0.4728). Furthermore, we compared the way the two observers clustered the patients, using the test for comparing two proportions (t value, two-sided test). There was no statistically significant difference between the two physicians, regardless of the patients’ real status.
CONCLUSION: Transabdominal real-time elastography is certainly a very useful method in depicting liver hardness, although it is incompletely tested in large multicenter studies.
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Abstract
Percutaneous liver biopsy (LB) remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever-increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances.
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Affiliation(s)
- Faisal M. Sanai
- Hepatology Unit, Department of Medicine, Riyadh Military Hospital; Liver Disease Research Center – King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Faisal M. Sanai, Division of Gastroenterology and Hepatology (A41), Department of Medicine, Riyadh Military Hospital, PO Box 7897, Riyadh-11159, Saudi Arabia. E-mail:
| | - Emmet B. Keeffe
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
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Liver biopsies for chronic hepatitis C: should nonultrasound-guided biopsies be abandoned? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:425-30. [PMID: 19543573 DOI: 10.1155/2009/370651] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVE Liver biopsy has been the gold standard for grading and staging chronic hepatitis C virus (HCV)- mediated liver injury. Traditionally, this has been performed by trained practitioners using a nonimage-guided percutaneous technique at the bedside. Recent literature suggests an expanding role for radiologists in obtaining biopsies using an ultrasound (US)-guided technique. The present study was undertaken study to determine if the two techniques produced liver biopsy specimens of similar quality and hypothesized that at our institution, non-US-guided percutaneous liver biopsies for HCV would be of higher quality than US-guided specimens. METHODS Liver biopsies from 100 patients with chronic HCV infection (50 consecutive US-guided and 50 consecutive non-US-guided), were retrospectively identified using a hospital histopathology database. All original biopsy slides were coded and prospectively reanalyzed by a single hepatopathologist who was blinded to the technique used in obtaining the biopsy. Additionally, all liver biopsies for chronic HCV infection completed at the centre from 1998 to 2007 were identified and the technique used was recorded. Biopsy quality was determined primarily by the number of complete portal tracts (CPTs) identifiable in the slides. The total length of specimen and the degree of fragmentation were secondary outcome measures. RESULTS There was a slight difference observed between the US-guided and non-US-guided groups in mean age (46.3 years versus 42.5 years, respectively; P=0.018) but no differences in sex, presence of cirrhosis, bilirubin, creatinine, international normalized ratio, and grade or stage of disease. Biopsies obtained using the US-guided technique produced higher quality specimens than the non-US-guided technique based on our primary outcome of number of CPTs in the biopsy (11.8 versus 7.4; P<0.001). US-guided specimens also were longer (24.4 mm versus 19.7 mm; P=0.001), had less fragmentation (P=0.016), and a higher overall histopathological quality assessment (P=0.026) than the non-US-guided biopsies. However, there was no significant difference between the two groups in the ability to grade and stage the disease (96% US-guided versus 90% in non-US-guided (P=0.20). Over a 10-year period, 763 biopsies for chronic HCV infection were identified with an obvious trend toward the increased use of US-guided technique observed at 2% in 1998 to 85% in 2007. CONCLUSIONS US-guided liver biopsies for chronic HCV are the most common method of obtaining specimens at the Kingston General Hospital, Kingston, Ontario, and are of higher quality than non-US-guided specimens. However, there is no significant difference in the two techniques in the ability to grade and stage chronic HCV.
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Abstract
Assessment of hepatic fibrosis is important for determining prognosis, guiding management decisions, and monitoring disease. Histological evaluation of liver biopsy specimens is currently considered the reference test for staging hepatic fibrosis. Since liver biopsy carries a small but significant risk, noninvasive tests to assess hepatic fibrosis are desirable. This editorial gives an overview on noninvasive methods currently available to determine hepatic fibrosis and their diagnostic accuracy for predicting significant fibrosis and cirrhosis in chronic hepatitis C. Based on available data, the performance of simple tests derived from routine laboratory parameters appears to be similar to that of more complex and expensive fibrosis panels. Transient elastography seems more accurate than blood tests for diagnosing cirrhosis.
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Affiliation(s)
- Rudolf-E Stauber
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
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