Nakanishi Yukihiro, Mneimneh Wadad S, Sey Michael, Al-Haddad Mohammad, DeWitt John M, Saxena Romil
*Department of Pathology and Laboratory Medicine †Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, IN.
Am J Surg Pathol. 2015 Jul;39(7):968-76. doi: 10.1097/PAS.0000000000000449.
The transgastric approach is a novel method for obtaining liver biopsies in patients undergoing upper gastrointestinal endosonography. Avoidance of vascular puncture and ability to acquire tissue in patients with obesity or ascites offers a practice niche for this technique. Although several series have reported on specimen adequacy, biopsy core length, and number of portal tracts, none has addressed the diagnostic challenges presented by the fragmented nature of these specimens. We systematically evaluated 113 transgastric liver biopsies obtained for diagnosis of parenchymal liver disease by 3 needle types and compared them with 100 percutaneous and 100 transjugular liver biopsies, respectively. Parameters recorded were number of tissue cores, sizes of longest and shortest cores, numbers of complete and incomplete portal tracts, morphologic characteristics, and adequacy of specimen for diagnosis and staging. In contrast to percutaneous and transjugular liver biopsies, transgastric biopsies often contained >10 tissue fragments and smaller tissue cores. In addition, 2 of the 3 types of transgastric needles obtained less numbers of complete portal tracts. Transjugular biopsies were also smaller and contained less number of complete portal tracts than percutaneous specimens but, unlike transgastric biopsies, only rarely contained >10 tissue fragments. Specimen adequacy for diagnosis and staging was 80%, 100%, and 98% for transgastric, percutaneous, and transjugular biopsies, respectively. Difference in specimen adequacy is related to tissue fragmentation of transgastric liver biopsies rather than biopsy core length or numbers of complete portal tracts. Tissue fragmentation is particularly challenging for staging chronic liver disease.
经胃途径是在上消化道内镜超声检查患者中获取肝活检组织的一种新方法。避免血管穿刺以及能够在肥胖或腹水患者中获取组织，为该技术提供了一个应用领域。尽管已有多个系列报道了标本充足率、活检芯长度和门管数量，但尚无研究探讨这些标本的碎片化性质所带来的诊断挑战。我们系统评估了通过3种针型获取的113例经胃肝活检组织，用于诊断实质性肝病，并分别与100例经皮肝活检组织和100例经颈静脉肝活检组织进行比较。记录的参数包括组织芯数量、最长和最短芯的大小、完整和不完整门管的数量、形态学特征以及标本用于诊断和分期的充足率。与经皮和经颈静脉肝活检不同，经胃活检组织通常包含>10个组织碎片且组织芯较小。此外，3种经胃针中的2种获取的完整门管数量较少。经颈静脉活检组织也比经皮标本小，且完整门管数量较少，但与经胃活检不同的是，很少包含>10个组织碎片。经胃、经皮和经颈静脉活检组织用于诊断和分期的标本充足率分别为80%、100%和98%。标本充足率的差异与经胃肝活检组织的碎片化有关，而非活检芯长度或完整门管数量。组织碎片化对慢性肝病分期尤其具有挑战性。
