评价肥胖症手术患者非酒精性脂肪性肝病中核心和楔形活检的组织学变异性。

Evaluation of the histological variability of core and wedge biopsies in nonalcoholic fatty liver disease in bariatric surgical patients.

机构信息

Department of Surgery, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Prahran, Melbourne, Australia.

Department of General Surgery, The Alfred Hospital, Melbourne, Australia.

出版信息

Surg Endosc. 2021 Mar;35(3):1210-1218. doi: 10.1007/s00464-020-07490-y. Epub 2020 Mar 13.

DOI:10.1007/s00464-020-07490-y

PMID:32170564

Abstract

BACKGROUND

Liver biopsy remains the gold standard for characterizing and evaluating treatment response in nonalcoholic fatty liver disease (NAFLD). Liver heterogeneity and sampling variability can affect the reliability of results. This study aimed to compare histological variability of intraoperative wedge and core liver biopsies from different lobes in bariatric patients, to better inform surgeons on biopsy method and guide interpretation of results.

METHODS

We prospectively recruited bariatric surgical patients. Intraoperative core biopsies were taken from the left and right lobe, with a wedge biopsy taken from the left. All biopsies were graded by a specialist liver pathologist, blinded to clinical details and biopsy site. Concordance of histological findings between sites was evaluated.

RESULTS

There were 91 participants (72.2% female), mean age 46.8 ± 12.0 years, body mass index 45.9 ± 9.4 kg/m. There was no significant pattern for up- or down-grading disease dependent on biopsy technique. Moderate to strong agreement was seen in the presence of NAFLD and nonalcoholic steatohepatitis (NASH, κ = 0.609-0.865, p < 0.001) between biopsy sites. Individual components (steatosis, inflammation, ballooning) showed weaker agreement (κ = 0.386-0.656, p < 0.01). Fibrosis showed particularly poor agreement (κ = 0.223-0.496, p < 0.01). Detection of pathology improved with a combination of biopsy techniques, compared to a single biopsy method.

CONCLUSION

Overall diagnosis of NAFLD or NASH shows good agreement between biopsy sites, but individual components, particularly fibrosis stage, vary significantly. Clinicians should consider biopsies from varied sites, to better assess liver disease severity. These data have important implications in fibrosis assessment of NAFLD and are relevant in the interpretation of histological efficacy of investigational pharmacotherapies.

TRIAL REGISTRATION

ACTRN12615000875505 (Australian Clinical Trials Register).

摘要

背景

肝活检仍然是诊断和评估非酒精性脂肪性肝病（NAFLD）的金标准。肝脏异质性和采样变异性可能会影响结果的可靠性。本研究旨在比较肥胖患者不同肝叶术中楔形和核心肝活检的组织学变异性，以便更好地为外科医生提供活检方法，并指导结果解释。

方法

我们前瞻性招募了接受减肥手术的患者。术中从左、右叶取核心活检，从左叶取楔形活检。所有活检均由一位肝脏病理专家进行分级，该专家对临床细节和活检部位均不知情。评估了不同部位组织学发现的一致性。

结果

共有 91 名参与者（72.2%为女性），平均年龄 46.8±12.0 岁，体重指数 45.9±9.4kg/m。根据活检技术，疾病的升档或降档没有明显的模式。在存在非酒精性脂肪肝和非酒精性脂肪性肝炎（NASH，κ=0.609-0.865，p<0.001）方面，活检部位之间存在中度至强烈的一致性。个别成分（脂肪变性、炎症、气球样变）的一致性较弱（κ=0.386-0.656，p<0.01）。纤维化显示出特别差的一致性（κ=0.223-0.496，p<0.01）。与单一活检方法相比，结合多种活检技术可提高对病理的检测。