Jain Dhanpat, Torres Richard, Celli Romulo, Koelmel Jeremy, Charkoftaki Georgia, Vasiliou Vasilis
Department of Anatomic Pathology, Yale University School of Medicine, New Haven, CT, USA.
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.
Transl Gastroenterol Hepatol. 2021 Apr 5;6:20. doi: 10.21037/tgh.2020.04.01. eCollection 2021.
Liver biopsies are commonly used to evaluate a wide variety of medical disorders, including neoplasms and post-transplant complications. However, its use is being impacted by improved clinical diagnosis of disorders, and non-invasive methods for evaluating liver tissue and as a result the indications of a liver biopsy have undergone major changes in the last decade. The evolution of highly effective treatments for some of the common indications for liver biopsy in the last decade (e.g., viral hepatitis B and C) has led to a decline in the number of liver biopsies in recent years. At the same time, the emergence of better technologies for histologic evaluation, tissue content analysis and genomics are among the many new and exciting developments in the field that hold great promise for the future and are going to shape the indications for a liver biopsy in the future. Recent advances in slide scanners now allow creation of "digital/virtual" slides that have image of the entire tissue section present in a slide [whole slide imaging (WSI)]. WSI can now be done very rapidly and at very high resolution, allowing its use in routine clinical practice. In addition, a variety of technologies have been developed in recent years that use different light sources and/or microscopes allowing visualization of tissues in a completely different way. One such technique that is applicable to liver specimens combines multiphoton microscopy (MPM) with advanced clearing and fluorescent stains known as Clearing Histology with MultiPhoton Microscopy (CHiMP). Although it has not yet been extensively validated, the technique has the potential to decrease inefficiency, reduce artifacts, and increase data while being readily integrable into clinical workflows. Another technology that can provide rapid and in-depth characterization of thousands of molecules in a tissue sample, including liver tissues, is matrix assisted laser desorption/ionization (MALDI) mass spectrometry. MALDI has already been applied in a clinical research setting with promising diagnostic and prognostic capabilities, as well as being able to elucidate mechanisms of liver diseases that may be targeted for the development of new therapies. The logical next step in huge data sets obtained from such advanced analysis of liver tissues is the application of machine learning (ML) algorithms and application of artificial intelligence (AI), for automated generation of diagnoses and prognoses. This review discusses the evolving role of liver biopsies in clinical practice over the decades, and describes newer technologies that are likely to have a significant impact on how they will be used in the future.
肝活检常用于评估多种医学病症，包括肿瘤和移植后并发症。然而，临床病症诊断水平的提高以及评估肝组织的非侵入性方法正影响着其使用，因此肝活检的适应症在过去十年中发生了重大变化。过去十年中，针对一些常见肝活检适应症（如乙型和丙型病毒性肝炎）的高效治疗方法的发展导致近年来肝活检数量有所下降。与此同时，组织学评估、组织成分分析和基因组学等更好技术的出现是该领域众多令人兴奋的新进展之一，对未来充满希望，并将塑造未来肝活检的适应症。玻片扫描仪的最新进展现在允许创建“数字/虚拟”玻片，其中包含玻片上整个组织切片的图像[全玻片成像（WSI）]。现在可以非常快速且以非常高的分辨率进行全玻片成像，使其能够用于常规临床实践。此外，近年来已经开发出多种技术，这些技术使用不同的光源和/或显微镜，以完全不同的方式实现组织可视化。一种适用于肝脏标本的技术将多光子显微镜（MPM）与先进的透明化和荧光染色相结合，即多光子显微镜下的透明化组织学（CHiMP）。尽管该技术尚未得到广泛验证，但它有可能提高效率、减少伪像并增加数据量，同时易于整合到临床工作流程中。另一种能够对包括肝脏组织在内的组织样本中的数千种分子进行快速深入表征的技术是基质辅助激光解吸/电离（MALDI）质谱。MALDI已经应用于临床研究环境，具有很有前景的诊断和预后能力，并且能够阐明可能成为新疗法开发靶点的肝脏疾病机制。从对肝组织的这种先进分析中获得的海量数据的合理下一步是应用机器学习（ML）算法和人工智能（AI），以自动生成诊断和预后。本综述讨论了几十年来肝活检在临床实践中不断演变的作用，并描述了可能对其未来使用方式产生重大影响的新技术。
