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Yang JR, Wu S, Li J, Tian XJ, Xue ZX, Niu XY. Hemothorax caused by injury of musculophrenic artery after ultrasound-guided percutaneous liver biopsy: a case report. J Med Case Rep 2024; 18:303. [PMID: 38918846 PMCID: PMC11202318 DOI: 10.1186/s13256-024-04619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/02/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Hemorrhage is the most common major complication after liver biopsy. Hemothorax is one type of bleeding and is very rare and dangerous. Several cases of hemothorax subsequent to liver biopsy have been documented, primarily attributed to injury of the intercostal artery or inferior phrenic artery and a few resulting from lung tissue damage; however, no previous case report of hemothorax caused by injury of musculophrenic artery after liver biopsy has been reported. CASE PRESENTATION A 45-year-old native Chinese woman diagnosed with primary biliary cirrhosis due to long-term redness in urination and abnormal blood test indicators was admitted to our hospital for an ultrasound-guided liver biopsy to clarify pathological characteristics and disease staging. A total of 2 hours after surgery, the patient complained of discomfort in the right chest and abdomen. Ultrasound revealed an effusion in the right thorax and hemothorax was strongly suspected. The patient was immediately referred to the interventional department for digital subtraction angiography. Super-selective angiography of the right internal thoracic artery was performed which revealed significant contrast medium extravasation from the right musculophrenic artery, the terminal branch of the internal thoracic artery. Embolization was performed successfully. The vital signs of the patient were stabilized after the transarterial embolization and supportive treatment. CONCLUSION This case draws attention to the musculophrenic artery as a potential source of hemorrhage after percutaneous liver biopsy.
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Affiliation(s)
- Jing-Ru Yang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Sai Wu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Jian Li
- Department of Interventional Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Xiao-Juan Tian
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Zhuo-Xi Xue
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Xiao-Yan Niu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
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DesRoche C, Callum J, Scholey A, Hajjaj OI, Flemming J, Mussari B, Tarulli E, Reza Nasirzadeh A, Menard A. Platelet and INR Thresholds and Bleeding Risk in Ultrasound Guided Percutaneous Liver Biopsy: A Before-After Implementation of the 2019 Society of Interventional Radiology Guidelines Observational Quality Improvement Study. Can Assoc Radiol J 2024:8465371241252059. [PMID: 38755999 DOI: 10.1177/08465371241252059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR) guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural guidelines resulted in reduced guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% (P = .01). The rate of pre-procedural transfusion remained the same pre and post guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post (P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events.
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Affiliation(s)
- Chloe DesRoche
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Aiden Scholey
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Omar I Hajjaj
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer Flemming
- Department of Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Ben Mussari
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Emidio Tarulli
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Amir Reza Nasirzadeh
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Alexandre Menard
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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Breznik S, Slanič A, Ivanecz A, Lučev J. Bilhemia After Percutaneous Liver Tumor Core Biopsy With the Percutaneous Embolization of Bilio-venous Fistula With Coils and Onyx. Cureus 2024; 16:e61414. [PMID: 38947602 PMCID: PMC11214701 DOI: 10.7759/cureus.61414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Bilhemia is a rare but potentially lethal condition representing abnormal communication and flow of bile into the bloodstream. We present a case of iatrogenic bilhemia after a percutaneous liver biopsy in a patient with cholangiocarcinoma. The bilio-venous fistula was visualized with percutaneous cholangiography and successfully embolized using coils and the liquid embolic agent Onyx. To our knowledge, this is the first report of using Onyx for the embolization of a bilio-venous fistula.
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Affiliation(s)
- Silva Breznik
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Aleš Slanič
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, SVN
| | - Jernej Lučev
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
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Fischer D, Toenges R, Kiil K, Michalik S, Thalhammer A, Bug G, Gökbuget N, Lang F. Liver failure after treatment with inotuzumab and polychemotherapy including PEG-asparaginase in a patient with relapsed Philadelphia chromosome-negative acute lymphoblastic leukemia. Ann Hematol 2024; 103:489-498. [PMID: 37999763 PMCID: PMC10798915 DOI: 10.1007/s00277-023-05495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023]
Abstract
We present the case of a 58-year-old female patient who presented with an extramedullary B-ALL relapse after prior allogenic HSCT and blinatumomab therapy. The patient died from complications of a drug-induced acute liver failure after a salvage therapy combining inotuzumab ozogamicin (InO)-based induction followed by consolidation with high dose MTX and pegaspargase based on the GMALL protocol for older ALL patients. After a diagnosis of the extramedullary relapse in the form of a retro vesical chloroma, the patient received an individualized multi-agent chemotherapy based on induction chemotherapy for older patients in combination with InO. After four administrations of InO, in combination with vincristine, dexamethasone, cytarabine, and cyclophosphamide, CT-imaging showed a reduction in volume of the chloroma and response to therapy. Consolidation with high-dose methotrexate and pegaspargase was administered. The patient developed toxic liver damage manifested by hyperbilirubinemia and progressive hepatic encephalopathy. The diagnostic criteria for VOD were met, and therapy with defibrotide was initiated. Liver biopsy revealed no histological signs of VOD but instead steatohepatitis indicative of drug-induced toxicity. The patient ultimately died of hemorrhagic shock through postinterventional hemorrhage after liver biopsy. In conclusion, although InO shows promising results in the therapy of r/r ALL with and without additional chemotherapy, the combination with MTX and pegaspargase in an intensively pretreated patient with relapse after HCST may impart an increased risk for liver-related toxicity. Special caution is required when assessing fitness for further liver toxic regimens. A key takeaway is also the reminder that InO can cause liver damage not only in the form of VOD but also through direct hepatocellular toxicity.
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Affiliation(s)
- Daniel Fischer
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Rosa Toenges
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kati Kiil
- Senckenberg Institute of Pathology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sabine Michalik
- Department of Radiology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Axel Thalhammer
- Department of Radiology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gesine Bug
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nicola Gökbuget
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Fabian Lang
- Department of Medicine, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Sasani MR, Rasekhi A. Complication Rate after Percutaneous Liver Biopsy Using a Real-time Ultrasound Approach and Introducing a Uniform Methodology: A Brief Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:57-61. [PMID: 38322162 PMCID: PMC10839144 DOI: 10.30476/ijms.2023.96982.2861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 02/08/2024]
Abstract
Following the initial liver biopsy attempts, several techniques using a wide range of methodologies and materials were developed. Many studies on the evaluation of post-liver biopsy complications were conducted. However, their fundamental limitation was significant variance in patient demographics and methodology, which might account for the inconsistent outcomes. Therefore, a uniform methodology to perform percutaneous liver biopsies that result in comparable outcomes around the world is required. This study aimed to determine the precise complication rate following percutaneous liver biopsy using a consistent method in all individuals. It also aimed to establish a consistent operating procedure for a percutaneous liver biopsy that yielded comparable outcomes. Between July 2018 and July 2019, 116 patients were enrolled in this retrospective study for percutaneous liver biopsy. All individuals underwent a biopsy using the same procedure. There was an attempt to exclude elements that could have an impact on the complication rate. For this purpose, the same type and size of needle were utilized. Moreover, a single needle pass, a subcostal approach, deep inspiration breath holding, identical pre- and post-biopsy preparation, real-time ultrasonography guidance, the use of a single operator, and the absence of sedation or general anesthesia were the other approaches that were used to minimize the impact of variables that could raise complication rates. The overall complication rate was 19.8%, of which 18.9% of patients experienced pain and mild bleeding, and one patient (0.9%) experienced hematoma necessitating precautionary hospitalization. The overall percentage of patients who experienced pain was 13.8%. No further complications were observed. The findings of this study could provide an accurate estimate of the post-liver biopsy complication rate. Furthermore, due to a lower complication rate than other practiced procedures, this uniform methodology could be an attractive alternative in clinical practice. However, more research is required to confirm these results.
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Affiliation(s)
- Mohammad Reza Sasani
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Koh S, Kwon H, Hwangbo L, Kim CW, Kim S, Hong SB. Decreased Bleeding-Related Adverse Events Using Track Embolization with Gelatin Sponge Slurry after Percutaneous Liver Biopsy: A Propensity Score-Matched Study. J Vasc Interv Radiol 2023; 34:2128-2136. [PMID: 37652299 DOI: 10.1016/j.jvir.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of track embolization using gelatin sponge slurry in percutaneous ultrasound (US)-guided liver biopsy. MATERIALS AND METHODS Among the 543 patients who underwent percutaneous US-guided liver biopsies between September 2018 and August 2021, 338 who did not undergo track embolization and 105 who underwent track embolization were included in the analysis. All procedures were performed with 18-gauge coaxial core biopsy needles. Patients' laboratory data were reviewed. Patients in both groups were subdivided into the following 2 groups: (a) those with targeted biopsy for a focal liver lesion and (b) those with nontargeted biopsy for a liver parenchyma. Moreover, postbiopsy events, such as transfusion and transarterial embolization, were assessed. To minimize selection bias, propensity score matching (PSM) was performed. RESULTS After PSM, all factors that could affect bleeding risk were well-matched and well-balanced between the 2 groups (P > .474). In the non-track embolization group, 17 (16.2%) patients experienced major or minor bleeding-related adverse events (AEs). In contrast, in the track embolization group, only 5 (4.8%) patients experienced major or minor bleeding-related AEs, which was significantly lower than that in the non-track embolization group (P = .007). All 5 (4.8%) cases of major bleeding-related AEs were observed in the non-track embolization group (P = .024). CONCLUSIONS In this study, a retrospective analysis was performed using PSM for percutaneous US-guided liver biopsy. Track embolization using gelatin sponge slurry is significantly superior in the prevention of bleeding-related AEs after US-guided liver biopsy.
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Affiliation(s)
- Sungho Koh
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea.
| | - Lee Hwangbo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Suk Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Seung Baek Hong
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
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Garrido I, Coelho R, Macedo G. Hospital discharge after percutaneous liver biopsy - less is more? Eur J Gastroenterol Hepatol 2023; 35:1186-1191. [PMID: 37577843 DOI: 10.1097/meg.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Liver biopsy is a technique frequently performed in clinical practice. However, the recommended surveillance period after the procedure is not established in the guidelines. The aim of this study was to assess the safety and patient satisfaction of hospital discharge 2 h after a percutaneous liver biopsy. METHODS Prospective monocentric study which included all patients who underwent percutaneous liver biopsy between December 2020 and November 2022. Individuals were discharged 2 h after the procedure according to a protocol that was implemented in our institution. RESULTS A total of 200 patients were included, the majority male (52.0%), with a median age of 52 years old (interquartile range (IQR) 40-60). Forty-two (21.0%) individuals had mild adverse events at the time of or within 2 h of the procedure. Most (90.4%) occurred in the first hour after the liver biopsy. Only 5 (2.5%) patients were kept under observation for 4 h due to abdominal/shoulder pain. There were no serious complications and no patient required subsequent admission. The majority of patients reported being satisfied/very satisfied (99.4%) and felt safe (98.9%) with this protocol. Most of the individuals showed a preference for early hospital discharge (97.3%). CONCLUSION We showed that patients requiring percutaneous liver biopsy can be safely discharged 2 h after the procedure.
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Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
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Androutsakos T, Dimitriadis K, Revenas K, Vergadis C, Papadakis DD, Sakellariou S, Vallilas C, Hatzis G. Liver Biopsy: To Do or Not to Do - A Single-Center Study. Dig Dis 2023; 41:913-921. [PMID: 37611545 DOI: 10.1159/000533328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION A variety of liver disorders are associated with characteristic histopathological findings that help in their diagnosis and treatment. However, percutaneous liver biopsy (PLB) is prone to limitations and complications. We evaluated all PLBs done in our hospital in a 13-year period, aiming to assess PLB's utility and complications. METHODS All PLBs conducted in an internal medicine department of a tertiary university hospital in Athens, Greece, during a 13-year period were reviewed. Recorded data included demographic characteristics, laboratory results acquired on biopsy day, indication for liver biopsy, and occurrence of side effects. All patients were followed for 1 month post-hospital discharge for possible PLB-related complications. RESULTS A total of 261 patients underwent PLB during the study period. The commonest indication of PLB was investigation of liver mass, followed by transaminasemia. PLB assisted in setting a diagnosis in 218 patients and was unhelpful in only 43, in 14 of them due to inadequate or inappropriate biopsy specimen. Complications attributable to PLB were rare, with 10 patients exhibiting pain, either at biopsy site or in the right shoulder, and 3 having bleeding episodes; no deaths were noted. CONCLUSIONS Our study shows that PLB is still a powerful diagnostic tool in everyday practice, provided it is used when indicated.
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Affiliation(s)
- Theodoros Androutsakos
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Dimitriadis
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | - Stratigoula Sakellariou
- 1st Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Vallilas
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Gregorios Hatzis
- Pathophysiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Chai WL, Lu DL, Sun ZX, Cheng C, Deng Z, Jin XY, Zhang TL, Gao Q, Pan YW, Zhao QY, Jiang TA. Major complications after ultrasound-guided liver biopsy: An annual audit of a Chinese tertiary-care teaching hospital. World J Gastrointest Surg 2023; 15:1388-1396. [PMID: 37555112 PMCID: PMC10405124 DOI: 10.4240/wjgs.v15.i7.1388] [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: 02/11/2023] [Revised: 04/05/2023] [Accepted: 05/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND As ultrasound-guided percutaneous liver biopsy (PLB) has become a standard and important method in the management of liver disease in our country, a periodical audit of the major complications is needed. AIM To determine the annual incidence of major complications following ultrasound-guided PLB and to identify variables that are significantly associated with an increased risk of major complications. METHODS A total of 1857 consecutive cases of PLB were included in our hospital from January 2021 to December 2021. The major complication rate and all-cause 30-d mortality rate were determined. Multivariate analyses were performed by logistic regression to investigate the risk factors associated with major complications and all-cause 30-d mortality following ultrasound-guided PLB. RESULTS In this audit of 1857 liver biopsies, 10 cases (0.53%) of major complications occurred following ultrasound-guided PLB. The overall all-cause mortality rate at 30 d after PLB was 0.27% (5 cases). Two cases (0.11%) were attributed to major hemorrhage within 7 d after liver biopsy. Fibrinogen less than 2 g/L [odds ratio (OR): 17.226; 95% confidence interval (CI): 2.647-112.102; P = 0.003], post-biopsy hemoglobin level (OR: 0.963; 95%CI: 0.942-0.985; P = 0.001), obstructive jaundice (OR: 6.698; 95%CI: 1.133-39.596; P = 0.036), application of anticoagulants/antiplatelet medications (OR: 24.078; 95%CI: 1.678-345.495; P = 0.019) and age (OR: 1.096; 95%CI: 1.012-1.187; P = 0.025) were statistically associated with the incidence of major complications after PLB. CONCLUSION In conclusion, the results of this annual audit confirmed that ultrasound-guided PLB can be performed safely, with a major complication rate within the accepted range. Strict patient selection and peri-biopsy laboratory assessment are more important than procedural factors for optimizing the safety outcomes of this procedure.
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Affiliation(s)
- Wei-Lu Chai
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Dan-Lei Lu
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Zhong-Xia Sun
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Chao Cheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Zhuang Deng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xin-Yan Jin
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Tong-Long Zhang
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Qiong Gao
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yu-Wei Pan
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Wilson S, Joseph J, Danta M, Rabbolini DJ. Viscoelastometry to Manage Bleeding in Liver Disease. Cureus 2023; 15:e41401. [PMID: 37546051 PMCID: PMC10402654 DOI: 10.7759/cureus.41401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
A state of "re-balanced haemostasis" describes complex coagulation changes that arise in patients with liver disease. Changes include alterations in procoagulant and anticoagulant proteins, platelets and von Willebrand factor, as well as the fibrinolytic system. Various circumstances including infection, trauma, or surgery may disrupt this balance and predispose an individual to bleeding or thrombosis. The prothrombin time, international normalised ratio, and activated partial thromboplastin time are conventional coagulation screening tests that are routinely employed by clinicians to investigate unexplained bleeding, monitor anticoagulation, and inform preoperative assessments of bleeding risk. These standard coagulation tests assess quantitative defects in procoagulant clotting factors and are insensitive to levels of natural anticoagulants, which together with procoagulant factors, are often perturbed in liver disease. Therefore, the prolongation of clotting times measured by these tests often does not reflect the multifaceted alterations of haemostasis in these patients. Viscoelastic testing (VET) provides a more encompassing assessment of clotting function by recording real-time viscoelastic changes in whole blood and includes parameters that provide information on coagulation factor function, platelet contribution to clot formation, as well as fibrinolysis. To date, VET has been employed to predict and inform transfusion support in obstetric, trauma, and cardiac surgical fields, and its use in patients undergoing liver transplantation is well established. The ability of VET to accurately predict bleeding risk and precisely guide transfusion algorithms for patients with liver disease undergoing other invasive procedures or experiencing bleeding complications has been the topic of research over the last decade. This review is a critical summary of this data and provides a detailed snapshot of the position of VET as a clinical tool in patients with liver disease.
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Affiliation(s)
- Samantha Wilson
- Gastroenterology and Hepatology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS
| | - Joanne Joseph
- Hematology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS
- Hematology, St. Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, AUS
| | - Mark Danta
- Gastroenterology and Hepatology, School of Clinical Medicine, St. Vincent's Healthcare Campus, Faculty of Medicine, University of New South Wales, Sydney, AUS
- Gastroenterology and Hepatology, St. Vincent's Hospital, Sydney, AUS
| | - David J Rabbolini
- Faculty of Medicine and Health, University of Sydney, Sydney, AUS
- Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
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Furtado FS, Badenes-Romero Á, Hesami M, Mostafavi L, Najmi Z, Queiroz M, Mojtahed A, Anderson MA, Catalano OA. External validation of a machine learning based algorithm to differentiate hepatic mucinous cystic neoplasms from benign hepatic cysts. Abdom Radiol (NY) 2023; 48:2311-2320. [PMID: 37055585 DOI: 10.1007/s00261-023-03907-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To externally validate an algorithm for non-invasive differentiation of hepatic mucinous cystic neoplasms (MCN) from benign hepatic cysts (BHC), which differ in management. METHODS Patients with cystic liver lesions pathologically confirmed as MCN or BHC between January 2005 and March 2022 from multiple institutions were retrospectively included. Five readers (2 radiologists, 3 non-radiologist physicians) independently reviewed contrast-enhanced CT or MRI examinations before tissue sampling and applied the 3-feature classification algorithm described by Hardie et al. to differentiate between MCN and BHC, which had a reported accuracy of 93.5%. The classification was then compared to the pathology results. Interreader agreement between readers across different levels of experience was evaluated with Fleiss' Kappa. RESULTS The final cohort included 159 patients, median age of 62 years (IQR [52.0, 70.0]), 66.7% female (106). Of all patients, 89.3% (142) had BHC, and the remaining 10.7% (17) had MCN on pathology. Agreement for class designation between the radiologists was almost perfect (Fleiss' Kappa 0.840, p < 0.001). The algorithm had an accuracy of 98.1% (95% CI [94.6%, 99.6%]), a positive predictive value of 100.0% (95% CI [76.8%, 100.0%]), a negative predictive value of 97.9% (95% CI [94.1%, 99.6%]), and an area under the receiver operator characteristic curve (AUC) of 0.911 (95% CI [0.818, 1.000]). CONCLUSION The evaluated algorithm showed similarly high diagnostic accuracy in our external, multi-institutional validation cohort. This 3-feature algorithm is easily and rapidly applied and its features are reproducible among radiologists, showing promise as a clinical decision support tool.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Álvaro Badenes-Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
- Department of Nuclear Medicine, Hospital Universitario de Tarragona Juan XXIII, Tarragona, Spain
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Leila Mostafavi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | | | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA.
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12
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Zhang L, Wu Y, He X, Zhao L, Li K. Post biopsy delayed liver hemorrhage successfully controlled by bedside CEUS-guided microwave ablation: A case report. Clin Case Rep 2023; 11:e6916. [PMID: 36789325 PMCID: PMC9909252 DOI: 10.1002/ccr3.6916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
We present a 60-year-old man suffering from delayed arterial hemorrhage post liver biopsy. Contrast-enhanced ultrasound was used to detect the bleeding point and to evaluate the efficacy of microwave ablation (MWA). The hemorrhage was controlled by MWA at the bedside. This is the first application of MWA for delayed hemorrhage.
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Affiliation(s)
- Lanxia Zhang
- Department of Medical UltrasonicsThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Yuxuan Wu
- Department of Medical UltrasonicsThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Xuqi He
- Department of Medical UltrasonicsThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Liwen Zhao
- Department of Medical UltrasonicsThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Kai Li
- Department of Medical UltrasonicsThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
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13
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Buckholz AP, Brown RS. Noninvasive Fibrosis Testing in Chronic Liver Disease Including Caveats. Clin Liver Dis 2023; 27:117-131. [PMID: 36400461 DOI: 10.1016/j.cld.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Assessment of liver fibrosis is important as the range of liver disease management has expanded, rendering biopsy both imperfect and impractical in many situations. Noninvasive tests of fibrosis leverage laboratory, imaging and elastography techniques to estimate disease extent, often with the goal of identifying advanced fibrosis. This review attempts to summarize their utility across a broad range of possible clinical scenarios while considering the central tenets of health care quality: access, quality, and cost. For each test, it also discusses the caveats whereby each test may have reduced effectiveness and how to consider each in a typical clinical setting.
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Affiliation(s)
- Adam P Buckholz
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue 4th Floor, New York, NY 10021, USA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue 4th Floor, New York, NY 10021, USA.
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14
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Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: The Prognostic Role of Liver Stiffness Measurement. Cancers (Basel) 2023; 15:cancers15030637. [PMID: 36765595 PMCID: PMC9913338 DOI: 10.3390/cancers15030637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), which is nowadays the most common etiology of chronic liver disease, is associated with an increased risk of hepatocellular carcinoma (HCC), with or without cirrhosis. Owing to the high prevalence of NAFLD worldwide, it becomes crucial to develop adequate strategies for surveillance of HCC and new prediction models aiming at stratifying NAFLD population for HCC risk. To this purpose, several noninvasive tests (NITs) have been proposed in the several last years, including clinical parameters, serum biomarkers, and imaging techniques. Most of these tools are focused on the assessment of liver fibrosis. Both ultrasound (US) elastography (especially transient elastography) and magnetic resonance (MR) elastography have been evaluated to estimate HCC risk in NAFLD patients. Recently, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) include these techniques among the recommended NITs for the assessment of liver fibrosis. The aim of this review is to summarize the most recent data on the role of US and MR elastography in HCC risk stratification in patients with NAFLD.
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15
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Handke NA, Ollig A, Attenberger UI, Luetkens JA, Faron A, Pieper CC, Schmeel FC, Kupczyk PA, Meyer C, Kuetting D. Percutaneous transhepatic biliary drainage: a retrospective single-center study of 372 patients. Acta Radiol 2022; 64:1322-1330. [PMID: 36128748 DOI: 10.1177/02841851221127809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complication rates in percutaneous transhepatic biliary drainage (PTBD) are non-uniform and vary considerably. In addition, the impact of peri-procedural risk factors is under-investigated. PURPOSE To compare success and complication rates of PTBD in patients with and without accompanying technical risk factors. MATERIAL AND METHODS A single-center retrospective study was conducted from January 2004 to December 2016. Patients receiving PTBD due to biliary obstruction or biliary leakage were included. Technical risk factors (non-distended bile ducts, ascites, obesity, anasarca, non-compliance) were assessed. Complications were classified according to the Society of Interventional Radiology. RESULTS In total, 372 patients were included (57.3% men, 42.7% women; mean age = 66 years). Overall, 466 PTBDs were performed. Of the patients, 70.1% presented with malignancy and biliary obstruction; 26.8% had benign biliary obstruction; 3.1% had biliary leakage. Technical risk factors were reported in 57 (15.3%) patients. Overall technical success of initial PTBD was 98.7%, primary technical success was 97.9%. In patients with non-dilatated bile ducts, primary technical success was 68.2%. Overall complication rate was 15.0% (8.1% major complications, 6.9% minor complications). Neither major nor minor complications were more frequent in patients with technical risk factors (P > 0.05). In left-sided PTBD, hemorrhage was more frequent (P = 0.015). Patients with malignancy were significantly more affected by drainage-related complications (P = 0.004; odds ratio = 2.03). The mortality rate was 0.5% (n = 2). CONCLUSION PTBD is a safe and effective method for the treatment of biliary obstruction and biliary leaks. Complication rates are low, even in procedures with risk factors.
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Affiliation(s)
- Nikolaus A Handke
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Annika Ollig
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Julian A Luetkens
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Patrick A Kupczyk
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
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16
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Garcia-Monaco RD, Chung JW, Vilgrain V, Bouattour M, Covey AM. Summary of key guidelines for locoregional treatment of HCC in Asia, Europe, South and North America. Br J Radiol 2022; 95:20220179. [PMID: 35848758 PMCID: PMC9815746 DOI: 10.1259/bjr.20220179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 01/26/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide accounting for over 800,000 new cases in 2018, with the highest incidence in Asia and Africa where hepatitis B is the most common risk factor. In Europe, Japan, and the United States, hepatitis C chronic alcohol abuse and non-alcoholic fatty liver disease are more common risk factors. Five-year survival is low, less than 20% worldwide. HCC is a particularly challenging disease to treat because therapeutic options and prognosis must also consider hepatitis or cirrhosis independent of the malignancy. Locoregional therapies (LRT) including ablation, arterially directed therapy and external beam radiation are the preferred treatments for patients with good performance status, unresectable disease limited to the liver and preserved liver function. In practice, patients with portal vein tumor thrombus and limited extrahepatic disease may also be considered candidates for LRT. There are several guidelines developed by expert panels provide recommendations on treating this challenging disease including the Barcelona Clinic Liver Cancer, European Association for the Study of the Liver, European Society for Medical Oncology, American Association for the Study of the Liver Diseases, and the National Comprehensive Cancer Network. The purpose of this paper is to review the guidelines as they are applied clinically in regions with high incidence of HCC.
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Affiliation(s)
- Ricardo D Garcia-Monaco
- Vascular and Interventional Radiology Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Valérie Vilgrain
- Department of Radiology, Department of OncHepatology Hopital Beaujon, APHP.Nord, Clichy, France
| | - Mohamed Bouattour
- Department of Radiology, Department of OncHepatology Hopital Beaujon, APHP.Nord, Clichy, France
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center Professor of Radiology, Weill Cornell Medical Center, New York, United States
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17
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Safety of percutaneous, image-guided biopsy of hepatocellular carcinoma with and without concurrent ablation. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2640-2646. [PMID: 35396970 DOI: 10.1007/s00261-022-03494-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique. METHODS In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging. Adverse events were graded using both the Clavien-Dindo Complication Classification system and the most recently proposed Society of Interventional Radiology (SIR) Adverse Event Classification System. RESULTS A total of 383 patients underwent 398 biopsies (64 ± 11 years; 112 women, 271 men). Most patients (282; 71%) underwent concurrent ablation. Adverse events occurred after 18 biopsies (4.5%): 13 were Grade I (Clavien-Dindo) or minor (SIR) and included hematoma (7), hepatic vein thrombus (2), portal vein thrombus (2), moderate pleural effusion (1), and small pneumothorax (1). The remaining 5 (1.3%) adverse events were classified as Grade II-IIIa (Clavien-Dindo) or moderate (SIR) and included hematoma requiring blood products (n = 1), arrhythmia (n = 1), and symptomatic pleural effusions requiring treatment (n = 3). Baseline age, sex, cause of liver disease, HCC diameter, and HCC grade were not associated with adverse events. There were no tumor seeding events after a median follow-up of 611 days (interquartile range of 211-1104). CONCLUSION Percutaneous image-guided tissue sampling using a standardized, indirect access, coaxial technique can be performed safely with and without concurrent ablation by trained cross-sectional interventional radiologists at a tertiary liver transplant center.
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18
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Comparison of clinical efficacy, subjective user experience, and safety for two different core biopsy needles, the Achieve® and Marquee®. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2632-2639. [PMID: 34181039 DOI: 10.1007/s00261-021-03187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare clinical efficacy, subjective radiologist preference, and complication rates for two different core biopsy needles, the Achieve® and Marquee®. METHODS Retrospective review included consecutive patients who underwent 18 gauge non-targeted core liver biopsy, 30 with Achieve® (Merit Medical) and 30 with Marquee® (BD Bard) Pathologist (blinded to needle type) reviewed specimen total length, maximum width, and portal triad count. Sixteen radiologists subjectively rated (1 to 5(best)) each needle for cocking, firing, recoil, chamber exposure, handling, and overall. A medical records search of all (targeted and non-targeted) core liver biopsies 1/1/17-9/30/2020 compared rates of major (requiring transfusion and/or embolization) and minor (self-limited bleeding) hemorrhagic complications. Comparison between needle types was performed using t-test. RESULTS For Achieve® and Marquee® needles, the respective mean (SD) for total length(mm) was 29.7(7.0) and 31.9(4.6), p = 0.1; max width(mm) was 0.78(0.1) and 0.85(0.1), p < 0.01; and number of portal triads was 15.3(5.3) and 17.3(5.3), p = 0.2. Radiologists subjectively preferred the Marquee® for several measures including cocking, chamber exposure, and overall (p < 0.02 for each), while the needles were rated similarly for firing, recoil, and handling. Review of 800 cases showed no difference in major (1.0% Achieve®, 1.9% Marquee®, p = 0.5) or minor (1.5% Achieve®, 0.5% Marquee®, p = 0.3) rates of hemorrhagic complications. CONCLUSION Liver biopsy specimens were significantly wider with Marquee® compared to Achieve®. Radiologists preferred the Marquee® for multiple tactile measures, while the major complication rate was not significantly different. While both needles have a similar side-notch design, the Marquee® needle demonstrates better sample quality and higher user preference, without compromising safety.
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19
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Kelly L, Simon P, Nash A, Thompson J, Affronti ML. Reducing Recovery Times in Outpatient Liver Biopsies: Role of the GI Nurse. Gastroenterol Nurs 2022; 45:238-243. [PMID: 35833740 DOI: 10.1097/sga.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
This project is aimed to identify whether recovery times could be reduced in patients undergoing an outpatient liver biopsy. Liver biopsies are typically performed in a hospital setting, and many facilities require patients to recover for multiple hours, sometimes ranging from 4 to 6 hours. This can discourage the patient from undergoing the biopsy. Multiple studies have examined recovery times and determined patients can safely recover and be discharged within 1-2 hours post-liver biopsy. In this retrospective review, the data of 60 outpatients who underwent a liver biopsy from June to December 2020 were analyzed. Analysis included comparing vital signs and symptoms at the 2-hour recovery period and 4-hour discharge time also to see whether there were any hospital admissions 1 week post-liver biopsy. Descriptive statistics were utilized for the data collected in this study. Results demonstrated that after 2 hours, 55 (91.7%) patients had vital signs within safe parameters, pain less than 5 on a 10-point pain scale and denied any other symptoms. The remaining five patients (8.3%) did not meet discharge criteria at the 2-hour mark because of pain greater than 5 on the pain scale yet were still discharged safely at the 4-hour mark.
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Affiliation(s)
- Lisa Kelly
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Peter Simon
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Angela Nash
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Julie Thompson
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Mary Lou Affronti
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
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20
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Androutsakos T, Voulgaris TA, Bakasis AD, Koutsompina ML, Chatzis L, Argyropoulou OD, Pezoulas V, Fotiadis DI, Papatheodoridis G, Tzioufas AG, Goules AV. Liver Fibrosis in Primary Sjögren’s Syndrome. Front Immunol 2022; 13:889021. [PMID: 35784296 PMCID: PMC9240196 DOI: 10.3389/fimmu.2022.889021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary Sjögren syndrome (pSS) is a systemic autoimmune epithelitis, potentially affecting salivary epithelium, biliary epithelium, and hepatocytes. Common immunological mechanisms might cause clinically silent liver inflammation, and combined with non-alcoholic fatty liver disease (NAFLD), liver fibrosis (LF) may occur. No studies have explored the occurrence of LF in the context of NAFLD among pSS patients. Methods Consecutive pSS patients from the rheumatology outpatient clinic of the Department of Pathophysiology and individuals evaluated in the hepatology outpatient clinic for possible NAFLD serving as comparators underwent transient elastography (TE) to assess LF and liver steatosis (LS). All participants had no overt chronic liver disease. Clinical, demographic, and laboratory data were collected from all participants at the time of TE. Results Fifty-two pSS patients and 198 comparators were included in the study. The median age (range) of pSS and comparators was 62.5 (30–81) and 55 (19–86) years, respectively. Both groups had similar prevalence regarding type 2 diabetes mellitus, hyperlipidemia, and similar body mass index (BMI). Patients with pSS had less frequently high LS (S2, S3) (27% vs. 62%, p < 0.001) and significant LF (F2–4) [2 (3.8%) vs. 34 (17.2%), p = 0.014] than comparators. Univariable analysis showed that advanced LF was significantly associated with older age, higher LS, greater BMI, and disease status (comparators than pSS); of these, only age was identified as an independent LF risk factor in the multivariable logistic regression analysis. Conclusion Liver fibrosis among pSS patients is most likely not attributed to the disease per se.
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Affiliation(s)
- Theodoros Androutsakos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros A. Voulgaris
- Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Loukia Koutsompina
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Loukas Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania D. Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Section, Institute of Molecular Biology and Biotechnology, Ioannina, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Section, Institute of Molecular Biology and Biotechnology, Ioannina, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas V. Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Andreas V. Goules,
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21
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Cox DRA, Low N, Goh SK, Lee E, Vago A, Jackett L, Lokan J, Braat S, Jones R, Testro A, Dobrovic A, Muralidharan V. Low Levels of Hepatocyte-Specific Methylation in Cell-Free DNA Are a Strong Negative Predictor for Acute T Cell-Mediated Rejection Requiring Treatment Following Liver Transplantation. Liver Transpl 2022; 28:1024-1038. [PMID: 34919754 DOI: 10.1002/lt.26388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
Graft-derived cell-free DNA (gdcfDNA) quantification is a promising, minimally invasive tool for detecting acute T cell-mediated rejection (ATCMR) following liver transplantation (LT). We investigated the utility of measuring hepatocyte-specific methylation in cfDNA (HS-cfDNA) to quantify gdcfDNA, examining its accuracy in detecting ATCMR in a prospective, cross-sectional study. Blood was collected from LT recipients immediately prior to graft biopsy for suspected rejection. HS-cfDNA was quantified using droplet-digital polymerase chain reaction. Prebiopsy liver function tests (LFTs) and HS-cfDNA levels were correlated with biopsy results and the primary outcome of treated biopsy-proven acute rejection (tBPAR). A total of 51 patients were recruited; 37 had evidence of rejection on biopsy and 20 required treatment. As much as 11 patients needed inpatient treatment for rejection. HS-cfDNA significantly outperformed LFTs in identifying patients with tBPAR, particularly those needing inpatient treatment (area under the curve, 73.0%; 95% confidence interval, 55.4%-90.6%; P = 0.01). At a threshold of <33.5% of the total cfDNA fraction, HS-cfDNA had a specificity of 97%, correctly excluding tBPAR in 30/31 patients. Quantifying graft-specific methylation in cfDNA has a major advantage over previous gdcfDNA techniques: it does not require genotyping/sequencing, lending it greater feasibility for translation into transplantation care. Low levels of HS-cfDNA were a strong negative predictor for tBPAR (negative predictive value, 86%) and may have a future role in triaging patients prior to invasive graft biopsies.
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Affiliation(s)
- Daniel R A Cox
- Department of Surgery - Austin Precinct, Austin Hospital, The University of Melbourne, Heidelberg, Melbourne, VIC, Australia.,HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.,Translational Genomics and Epigenomics Laboratory, Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Nicholas Low
- Department of Surgery - Austin Precinct, Austin Hospital, The University of Melbourne, Heidelberg, Melbourne, VIC, Australia.,HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Su Kah Goh
- HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Eunice Lee
- HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Angela Vago
- Liver Transplant Unit, Department of Gastroenterology & Hepatology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Louise Jackett
- Department of Anatomical Pathology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Julie Lokan
- Department of Anatomical Pathology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,MISCH (Methods and Implementation Support for Clinical Health Research Hub), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Robert Jones
- Department of Surgery - Austin Precinct, Austin Hospital, The University of Melbourne, Heidelberg, Melbourne, VIC, Australia.,HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.,Liver Transplant Unit, Department of Gastroenterology & Hepatology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Adam Testro
- Liver Transplant Unit, Department of Gastroenterology & Hepatology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Alexander Dobrovic
- Translational Genomics and Epigenomics Laboratory, Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery - Austin Precinct, Austin Hospital, The University of Melbourne, Heidelberg, Melbourne, VIC, Australia.,HPB & Transplant Surgery Unit, Department of Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
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22
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Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2022; 64:497-505. [DOI: 10.1016/j.rxeng.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
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23
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Fecher LA, Bishu S, Fontana RJ, Hayek SS, Schneider BJ. The Role of Tissue Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity. J Natl Compr Canc Netw 2022; 20:417-425. [PMID: 35390763 DOI: 10.6004/jnccn.2022.7011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment of cancer and are now omnipresent. However, immune-related adverse events can present with varying phenotypes and timing, which can pose diagnostic and therapeutic challenges for the treating oncologist as well as subspecialty consultants. Biopsies of affected organs may provide insight into biologic mechanisms as well as potentially guide management in certain circumstances.
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Affiliation(s)
| | | | | | - Salim S Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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24
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Yoo HW, Kim SG, Jang JY, Yoo JJ, Jeong SW, Kim YS, Kim BS. Two-dimensional shear wave elastography for assessing liver fibrosis in patients with chronic liver disease: a prospective cohort study. Korean J Intern Med 2022; 37:285-293. [PMID: 34865414 PMCID: PMC8925940 DOI: 10.3904/kjim.2020.635] [Citation(s) in RCA: 5] [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: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The objective of this study was to determine whether the newly developed two-dimensional shear wave elastography (2D-SWE, RS85, Samsung-shearwave imaging) was more valid and reliable than transient elastography (TE) for predicting the stage of liver fibrosis. METHODS The study prospectively enrolled a total of 116 patients with chronic liver disease who underwent 2D-SWE, TE, laboratory testing, and liver biopsy on the same day from two tertiary care hospitals. One patient with unreliable measurement was excluded. The measurement of 2D-SWE was considered acceptable when a homogenous color pattern in a region of interest of at least 10 mm was detected at 10 different sites. Diagnostic performance was calculated using area under the receiver operating characteristic curve (AUROC). RESULTS Liver fibrosis stages included F0 (18%), F1 (19%), F2 (24%), F3 (22%), and F4 (17%). Interclass correlation coefficient for inter-observer agreement in 2D-SWE was 0.994 (95% confidence interval [CI], 0.988 to 0.997). Overall, the results of 2D-SWE and stages of histological fibrosis were significantly correlated (r = 0.601, p < 0.001). For The 2D-SWE showed good diagnostic ability (AUROC, 0.851; 95% CI, 0.773 to 0.911) comparable to TE (AUROC, 0.859; 95% CI, 0.781 to 0.916) for the diagnosis of significant fibrosis (≥ F2), and the cut-off value was 5.8 kPa. AUROC and optimal cut-off of 2D-SWE for the diagnosis of liver cirrhosis were 0.889 (95% CI, 0.817 to 0.940) and 9.6 kPa, respectively. TE showed similar diagnostic performance in distinguishing cirrhosis (AUROC, 0.938; 95% CI, 0.877 to 0.974; p = 0.08). CONCLUSION 2D-SWE is comparable to TE in diagnosing significant fibrosis and liver cirrhosis with high reliability.
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Affiliation(s)
- Hae Won Yoo
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Sang Gyune Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Jae Young Jang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul,
Korea
| | - Jeong-Ju Yoo
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul,
Korea
| | - Young Seok Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Boo Sung Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul,
Korea
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25
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Xie Y, Gao P, He F, Zhang C. Application of Alginate-Based Hydrogels in Hemostasis. Gels 2022; 8:gels8020109. [PMID: 35200490 PMCID: PMC8871293 DOI: 10.3390/gels8020109] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Hemorrhage, as a common trauma injury and clinical postoperative complication, may cause serious damage to the body, especially for patients with huge blood loss and coagulation dysfunction. Timely and effective hemostasis and avoidance of bleeding are of great significance for reducing body damage and improving the survival rate and quality of life of patients. Alginate is considered to be an excellent hemostatic polymer-based biomaterial due to its excellent biocompatibility, biodegradability, non-toxicity, non-immunogenicity, easy gelation and easy availability. In recent years, alginate hydrogels have been more and more widely used in the medical field, and a series of hemostatic related products have been developed such as medical dressings, hemostatic needles, transcatheter interventional embolization preparations, microneedles, injectable hydrogels, and hemostatic powders. The development and application prospects are extremely broad. This manuscript reviews the structure, properties and history of alginate, as well as the research progress of alginate hydrogels in clinical applications related to hemostasis. This review also discusses the current limitations and possible future development prospects of alginate hydrogels in hemostatic applications.
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Affiliation(s)
| | | | | | - Chun Zhang
- Correspondence: ; Tel.: +86-027-85726712
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26
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Khalifa A, Sasso R, Rockey DC. Role of Liver Biopsy in Assessment of Radiologically Identified Liver Masses. Dig Dis Sci 2022; 67:337-343. [PMID: 33604792 PMCID: PMC8999003 DOI: 10.1007/s10620-021-06822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite improvements in imaging techniques that have enhanced the ability to diagnose hepatocellular carcinoma (HCC), histopathological evaluation of many other types of liver masses is critical. AIMS To evaluate the utility of liver biopsy in patients with radiologically undiagnosed liver masses. METHODS We retrospectively analyzed 293 consecutive patients who had a liver biopsy for evaluation of an undiagnosed liver mass between January 2014 and January 2018. RESULTS Out of 293 biopsies, 246 patients were found to have malignancy (84%), including 210 (72%) patients with metastatic malignancy and 36 with primary hepatic malignancies (20 HCC and 16 others). In the 47 patients without malignancy, 17 patients had necrotic abscess/granuloma, 16 patients had normal histology, eight patients had hepatic fibrosis/cirrhosis without malignant foci, and six patients had benign tumors. The most common primary lesion in patients with liver metastasis was breast carcinoma (32/293, 11%), followed by colon and pancreas (31 (each)/293, 11%), and lung (9%) adenocarcinomas. Histopathological analysis confirmed the presence of metastasis in 165/200 (83%) patients with a history of oncological malignancy and in 45/93 (48%) patients who had no malignancy history. CONCLUSIONS In patients with a radiologically identified liver mass of unclear etiology, liver biopsy/histology made a diagnosis in 95% (277/293) of patients, including 84% (246/293) found to have an oncological malignancy. Liver biopsy/histology also identified malignancy in a high proportion of patients without known underlying cancer. We conclude that liver biopsy is valuable for evaluation of radiologically identified liver masses of unclear etiology.
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Affiliation(s)
- Ali Khalifa
- Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 908, CSB, Charleston, SC 29425, USA
| | - Roula Sasso
- Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 908, CSB, Charleston, SC 29425, USA
| | - Don C. Rockey
- Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 908, CSB, Charleston, SC 29425, USA
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27
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Handke NA, Koch DC, Muschler E, Thomas D, Luetkens JA, Attenberger UI, Kuetting D, Pieper CC, Wilhelm K. Bleeding management in computed tomography-guided liver biopsies by biopsy tract plugging with gelatin sponge slurry. Sci Rep 2021; 11:24506. [PMID: 34969958 PMCID: PMC8718535 DOI: 10.1038/s41598-021-04155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023] Open
Abstract
To evaluate the safety and impact of biopsy tract plugging with gelatin sponge slurry in percutaneous liver biopsy. 300 consecutive patients (158 females, 142 males; median age, 63 years) who underwent computed tomography-guided core biopsy of the liver in coaxial technique (16/18 Gauge) with and without biopsy tract plugging were retrospectively reviewed (January 2013 to May 2018). Complications were rated according to the common criteria for adverse events (NCI-CTCAE). The study cohort was dichotomized into a plugged (71%; n = 214) and an unplugged (29%; n = 86) biopsy tract group. Biopsy tract plugging with gelatin sponge slurry was technically successful in all cases. Major bleeding events were only observed in the unplugged group (0.7%; n = 2), whereas minor bleedings (4.3%) were observed in both groups (plugged, 3.6%, n = 11; unplugged, 0.7%, n = 2). Analysis of biopsies and adverse events showed a significant association between number of needle-passes and overall (P = 0.038; odds ratio: 1.395) as well as minor bleeding events (P = 0.020; odds ratio: 1.501). No complications associated with gelatin sponge slurry were observed. Biopsy tract plugging with gelatin sponge slurry is a technically easy and safe procedure that can prevent major bleeding events following liver biopsy.
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Affiliation(s)
- Nikolaus A Handke
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany.
- Department of Radiology, University Hospital Bonn, Bonn, Germany.
| | - Dennis C Koch
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
| | - Eugen Muschler
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | | | | | - Daniel Kuetting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Kai Wilhelm
- Department of Radiology, Johanniter-Hospital Bonn, Bonn, Germany
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Mulazzani L, Terzi E, Casadei G, Pasquali V, Felicani C, Stefanini F, Granito A, Serra C, Piscaglia F. Retrospective analysis of safety of ultrasound-guided percutaneous liver biopsy in the 21st century. Eur J Gastroenterol Hepatol 2021; 33:e355-e362. [PMID: 35048647 DOI: 10.1097/meg.0000000000002080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ultrasound-guided percutaneous liver biopsy is a standard procedure, but it might be burdened with serious adverse events, mainly hemorrhagic. Literature lacks recent studies taking into account new ultrasound machines, more sensitive to tiny vessels and the evolution of the bioptic technique, including ultrasound guidance in all instances. Hence, the primary aim of this study was to evaluate complication rates of ultrasound-guided percutaneous liver biopsy in a recent population. Secondary aims were to evaluate if the experience of operator is a determinant of risk of complication and to identify other potential risk factors. METHODS We evaluated 800 procedures carried out in one hospital in the period 2010-2018. RESULTS Complication rate resulted in 4%, with the occurrence of moderate hemorrhagic complications in 0.75%. No cases of severe events or death were registered. A higher risk of bleeding was found to be associated with less experienced operators, while the need to perform multiple needle insertions increased the probability of adverse events. CONCLUSION The present findings confirmed ultrasound-guided percutaneous liver biopsy to be a substantially safe procedure with a low risk of overall adverse events and bleeding in particular, especially when performed by expert operators.
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Affiliation(s)
- Lorenzo Mulazzani
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Eleonora Terzi
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Giacomo Casadei
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Valentina Pasquali
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Cristina Felicani
- Department of organ insufficiency and transplantation, Departmental Program of Diagnostic and Therapeutic Interventional Ultrasound, Policlinico di S. Orsola, Bologna, Italy
| | - Federico Stefanini
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Alessandro Granito
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
| | - Carla Serra
- Department of organ insufficiency and transplantation, Departmental Program of Diagnostic and Therapeutic Interventional Ultrasound, Policlinico di S. Orsola, Bologna, Italy
| | - Fabio Piscaglia
- Unit of Internal Medicine, Policlinico di S. Orsola, University of Bologna
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Liver Biopsy in Pregnancy: Two Case Reports and Review of the Literature. Dig Dis Sci 2021; 66:4090-4098. [PMID: 33433812 DOI: 10.1007/s10620-020-06786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/14/2020] [Indexed: 12/09/2022]
Abstract
The etiology of most cases of liver diseases in pregnancy can be diagnosed with a thorough history, physical examination, laboratory values, serology, and noninvasive imaging. However, atypical clinical and laboratory presentations of liver diseases/chemistries require a liver biopsy to render an accurate diagnosis in cases where the biopsy results affect the timing of delivery or impact choice of medical therapy. According to the American College of Gastroenterology, liver biopsy can be effectively and safely conducted in pregnant women. Conventional routes of performing a liver biopsy include the percutaneous, transjugular route, and surgical methods. Endoscopic ultrasound-guided liver biopsy is a recent technique that has not yet gained widespread adoption but can potentially serve as an alternative route for obtaining the liver sample. Adverse events associated with liver biopsy include abdominal pain and hemorrhage. Maternal and fetal outcomes are limited to increased risk of preterm birth and small for gestational age neonate. However, very few studies have formally evaluated the safety of liver biopsy in pregnant women. In this review, we present two successful cases of liver biopsy performed during pregnancy and summarize the most recent evidence regarding the safety and outcomes of the procedure in pregnancy to assist clinicians in their decision to perform a liver biopsy during pregnancy or postpone it until after delivery.
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30
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Santos-Veloso MAO, Souza GLOD, Sá AFD. Prophylactic blood transfusion prior to elective invasive procedures. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1353-1360. [PMID: 34816934 DOI: 10.1590/1806-9282.20210468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Marcelo Antônio Oliveira Santos-Veloso
- Hospital dos Servidores do Estado de Pernambuco, Serviço de Clínica Médica - Recife (PE), Brazil.,Universidade Federal de Pernambuco, Centro de Biociências, Programa de Pós-Graduação em Inovação Terapêutica - Recife (PE), Brazil.,Centro Universitário Maurício de Nassau, Curso de Medicina, Departamento de Saúde - Recife (PE), Brazil
| | - Gustavo Lago Oliveira de Souza
- Hospital dos Servidores do Estado de Pernambuco, Serviço de Clínica Médica - Recife (PE), Brazil.,Hospital Barão de Lucena, Serviço de Urgência e Emergência - Recife (PE), Brazil
| | - Alessandra Ferraz de Sá
- Hospital dos Servidores do Estado de Pernambuco, Serviço de Clínica Médica - Recife (PE), Brazil.,Fundação de Hematologia e Hemoterapia de Pernambuco, Serviço de Hematologia - Recife (PE), Brazil
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31
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Zhong C, Jin J, Wang X, Huang Y, Yan D, Wang W. Effects of Different Recovery Positions on the Postpercutaneous Liver Biopsy Complications: A Metaanalysis. Front Surg 2021; 8:707945. [PMID: 34778353 PMCID: PMC8586080 DOI: 10.3389/fsurg.2021.707945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aim to evaluate the effects of different recovery positions on the adverse events and the patient acceptability in those who underwent percutaneous liver biopsy (PLB). Methods: A literature search was conducted in the Cochrane Library, Embase, Scopus, PubMed, CNKI, Sinomed, and Wanfang databases. The time for the article extraction was until July 2020. The articles were screened by two independent researchers, together with the bias risk evaluation and data extraction. The RevMan 5.4 software was utilized for the metaanalysis. Results: Finally, two articles involving 180 subjects were eligible for this study. Metaanalysis showed that at T0, the alternation between right-side and combined position (CRP) would induce an elevation of post-PLB pain compared with the dorsal/supine position (SRP) [WMD = -2.00, 95% CI (-3.54, -0.47), p = 0.01]. There were no statistical differences in the postoperative pain among the CRP, SRP, and right-side position (RRP). The patient acceptability of SRP and RRP was higher than that of the CRP. Finally, two eligible studies were included, which showed no incidence of pneumothorax and abdominal bleeding. Conclusions: CRP would induce post-PLB pain at T0. SRP was the most acceptable position for the cases that underwent PLB. There were no statistical differences in the incidence of pneumothorax and abdominal bleeding. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42020196633.
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Affiliation(s)
- Chengli Zhong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jiandi Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xiaoyan Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yandi Huang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong Yan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wei Wang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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32
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Chen M, Wu Z, Du Z, Sun S, Wu J, Luo J. Diagnostic accuracy of red blood cell distribution width to platelet ratio for predicting liver fibrosis in patients with chronic hepatitis B: A meta-analysis. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:361-372. [PMID: 34757161 DOI: 10.1016/j.gastrohep.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/17/2021] [Accepted: 10/25/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aims to systematically review the performance of red blood cell distribution width to platelet ratio (RPR) in the diagnosis of significant or advanced fibrosis, and cirrhosis associated with Hepatitis B virus (HBV). METHODS The relevant studies were comprehensively searched in English databases such as Web of Science, PubMed, EMBASE, Cochrane Library, as well as Chinese databases such as China National Knowledge Infrastructure, Wanfang Data from the inception to March 2021. Accuracy of RPR in diagnosing significant or advanced fibrosis and liver cirrhosis was assessed by area under the curve (AUC), pooled sensitivity and specificity, as well as positive and negative likelihood ratios. Stata 15.0 software was applied to analyze the data. RESULTS In total, 13 literature met the requirements, including patients with significant fibrosis (n=1890), advanced fibrosis (n=645), and cirrhosis (n=499). The prevalence rates of significant fibrosis, advanced fibrosis and cirrhosis were 49.31% (range: 17.25%-84.21%), 37.07% (range: 9.60%-58.20%) and 2.18% (range: 2.78%-44.19%), respectively. The AUCs for predicting significant fibrosis, advanced fibrosis, and cirrhosis by RPR were 0.73 (95%CI: 0.69-0.76),0.80 (95%CI: 0.77-0.84) and 0.80 (95%CI: 0.76-0.83), respectively. CONCLUSION RPR is of some diagnostic value to the prediction of HBV-related significant fibrosis, advanced fibrosis and cirrhosis.This conclusion is urgently needed to be verified by further multi-center studies of large sample size and rigorous design.
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Affiliation(s)
- Mingfa Chen
- Department of Infectious Diseases, Shenzhen Luohu People's Hospital, the third Affiliated Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - Zhiguo Wu
- Department of Infectious Diseases, the second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Zhan Du
- Healthcare center, Shenzhen Luohu People's Hospital, the third Affiliated Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - Shuilin Sun
- Department of Infectious Diseases, the second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Jun Wu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Luo
- Department of Infectious Diseases, Shenzhen Luohu People's Hospital, the third Affiliated Hospital, Shenzhen University, Shenzhen, Guangdong, China.
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33
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Abstract
Platelets are commonly transfused either therapeutically or prophylactically to maintain hemostasis. Most platelet transfusions are used to manage patients with hematologic malignancies. Although platelet transfusion guidelines have been published, platelet transfusion practices are still heterogeneous. Platelet transfusion guidelines partly lack recommendations or differ in the platelet threshold recommendations in some clinical situations. This article reviews platelet transfusions focusing on transfusion guidelines and platelet thresholds in different clinical settings.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010-3000, USA
| | - Zaher K Otrock
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Henry Ford Hospital, K6, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
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34
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Zhou F, Stueck A, McLeod M. Liver biopsy complication rates in patients with non-alcoholic fatty liver disease. CANADIAN LIVER JOURNAL 2021; 5:106-112. [DOI: 10.3138/canlivj-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: With new treatments for non-alcoholic fatty liver disease (NAFLD) on the horizon, it will be important to risk-stratify patients based on degree of fibrosis to allocate treatment to those at highest risk. No studies have examined the complication rates of liver biopsies in patients with NAFLD in the outpatient setting. METHODS: We conducted a retrospective chart review of all outpatient elective liver biopsies for NAFLD at a tertiary care centre over a 10-year period. Demographic variables and stage of fibrosis were recorded. Complications up to 1-week post-procedure were recorded. We used univariate logistic regression models to estimate the odds of major complications by fibrosis stage, age, sex, platelets, and international normalized ratio (INR). RESULTS: There were 582 biopsies reviewed in total. The mean age was 53 years. There was an even proportion of males to females. The mean fibrosis stage was 1.9; platelet count was 223.9, INR was 1, and partial thromboplastin time (PTT) was 31. Major complications occurred in 8 out of 582 biopsies (1.4%). Bleeding accounted for 6 of the major complications observed, while infection and pneumoperitoneum each occurred once. There were no statistically significant associations between age (odds ratio [OR] 0.97, 95% CI 0.92–1.03), female sex (OR 1.00, 95% CI 0.25–4.04), platelet count <150 (OR 0.59, 95% CI [-inf.], 3.86), INR >1.3 (OR 0.47, 95% CI 0.057–3.85), fibrosis stage, and complication rate. CONCLUSIONS: Our results are consistent with previous studies examining complication rates in other patient populations and clinical settings and support the overall safety of liver biopsies.
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Affiliation(s)
- Felix Zhou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Stueck
- Department of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magnus McLeod
- Division of General Internal Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Ren Y, Yang L, Li M, Wang J, Yan H, Ma N, Liu W, Wang L, Gao X, Gao P, Li T, Liu D. 4210 Da and 1866 Da polypeptides as potential biomarkers of liver disease progression in hepatitis B virus patients. Sci Rep 2021; 11:16982. [PMID: 34417517 PMCID: PMC8379215 DOI: 10.1038/s41598-021-96581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/12/2021] [Indexed: 12/18/2022] Open
Abstract
HBV infection is recognized as a serious global health problem, and hepatitis B virus infection is a complicated chronic disease leading to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). New biochemical serum markers could be used to advance the diagnosis and prognosis of HBV-associated liver diseases during the progression of chronic hepatitis B into cirrhosis and HCC. We determined whether the 4210 Da and 1866 Da polypeptides are serum metabolite biomarkers of hepatopathy with hepatitis B virus. A total of 570 subjects were divided into five groups: healthy controls, those with natural clearance, and patients with CHB, LC, and HCC. The 1866 Da and 4210 Da polypeptides were measured by Clin-ToF II MALDI-TOF-MS. There were significant differences in 4210 Da and 1866 Da levels among the five groups (P < 0.001). For the differential diagnosis of CHB from normal liver, the areas under the receiver operating characteristic (ROC) curve of 4210 Da and 1866 Da and their combination via logistic regression were 0.961, 0.849 and 0.967. For the differential diagnosis of LC from CHB, the areas under the ROC curve were 0.695, 0.841 and 0.826. For the differential diagnosis of HCC from CHB, the areas under the ROC curve were 0.744, 0.710 and 0.761, respectively. For the differential diagnosis of HCC from LC, the areas under the ROC curve of 4210 Da and 1866 Da were 0.580 and 0.654. The positive rate of 1866 Da was 45.5% and 69.0% in AFP-negative HCC patients and that of 4210 Da was 60.6% 58.6% in AFP-negative HCC patients of the study HCC vs. CHB and HCC vs. LC. The 4210 Da and 1866 Da polypeptide levels were positively correlated with HBV DNA levels (P < 0.001, r = 0.269; P < 0.001, r = 0.285). The 4210 Da and 1866 Da polypeptides had good diagnostic value for the occurrence and progression of HBV-related chronic hepatitis, liver cirrhosis and hepatocellular carcinoma and could serve to accurately guide treatment management and predict clinical outcomes.
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Affiliation(s)
- Yuanyuan Ren
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
- Department of Food Quality and Safety, College of Food Science and Biology, Hebei University of Science and Technology, Shijiazhuang, 050018, China
| | - Lei Yang
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Man Li
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Jian Wang
- Department of Epidemiology, Hebei North University, Zhangjiakou, 075000, China
| | - Huimin Yan
- Clinical Research Center, Shijiazhuang Fifth Hospital, Shijiazhuang, 050021, China
| | - Ning Ma
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Wenxuan Liu
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Liqin Wang
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xia Gao
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Ping Gao
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Tao Li
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Dianwu Liu
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China.
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do Amaral RH, Deprez FC, Dalla-Bona JP, Watte G, Roxo RS, Marchiori E, Hochhegger B. Need for analgesia after percutaneous liver biopsy: a real-life experience. Radiol Bras 2021; 54:165-170. [PMID: 34108763 PMCID: PMC8177684 DOI: 10.1590/0100-3984.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate variables affecting the need for analgesia after ultrasound-guided percutaneous liver biopsy performed on an outpatient basis. Materials and Methods This was a retrospective analysis of 1,042 liver biopsies performed between 2012 and 2018. The data collected included the age and sex of the patient, as well as self-reported pain in the recovery room, the pain treatment used, the indication for the biopsy, and the lobe punctured. As per the protocol of our institution, physicians would re-evaluate patients with mild pain (1-3 on a visual analog scale), prescribe analgesics for those with moderate pain (4-6 on the visual analog scale), and prescribe opioids for those with severe pain (7-10 on the visual analog scale). Results The main indications for biopsy were related to diffuse disease (in 89.9%), including the follow-up of hepatitis C (in 47.0%) and suspicion of nonalcoholic steatohepatitis (in 38.0%). Pain requiring analgesia occurred in 8.0% of procedures. Of the 485 female patients, 51 (10.5%) needed analgesia, compared with 33 (5.9%) of the 557 male patients (p < 0.05). The need for analgesia did not differ in relation to patient age, the lobe punctured, or the indication for biopsy (nodular or diffuse disease). The analgesic most commonly used was dipyrone (in 75.9%), followed by paracetamol alone (16.4%) and their combination with opioids (7.6%). Conclusion Ultrasound-guided percutaneous liver biopsy is safe and well tolerated. Postprocedural pain does not correlate with the lobe punctured, patient age, or the indication for biopsy and appears to affect more women than men.
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Affiliation(s)
- Ricardo Holderbaum do Amaral
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - João Pedro Dalla-Bona
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Guilherme Watte
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Rômulo Santos Roxo
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Bruno Hochhegger
- Laboratório de Pesquisa em Imagens Médicas (Labimed) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Coral GP, Branco F, Meurer R, Marcon PDS, Fontes PRO, Mattos AAD. RESULTS OF IMMUNOHISTOCHEMISTRY IN THE DIFFERENTIAL DIAGNOSIS OF EARLY HEPATOCELLULAR CARCINOMA AND NODULES WITH HIGH-GRADE DYSPLASIA IN PATIENTS WITH CIRRHOSIS. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:82-86. [PMID: 33909802 DOI: 10.1590/s0004-2803.202100000-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies. OBJECTIVE To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC. METHODS Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant. RESULTS One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%. CONCLUSION Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.
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Affiliation(s)
- Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
| | - Fernanda Branco
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Radiologia, Porto Alegre, RS, Brasil
| | - Rosalva Meurer
- UFCSPA, Departamento de Patologia, Porto Alegre, RS, Brasil
| | - Patrícia Dos Santos Marcon
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil.,Hospital Mãe de Deus, Departamento de Gastroenterologia, Porto Alegre, RS, Brasil
| | - Paulo Roberto Ott Fontes
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
| | - Angelo Alves de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
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Eltrombopag reduces bleeding complications and the need of platelet transfusions in cirrhotic thrombocytopenic patients subjected to invasive procedures. Blood Coagul Fibrinolysis 2021; 32:163-166. [PMID: 33555693 DOI: 10.1097/mbc.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures. Cardiovasc Intervent Radiol 2021; 44:523-536. [PMID: 33474606 DOI: 10.1007/s00270-020-02763-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for peri-operative anticoagulation management during interventional radiology procedures.
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Hayashi M, Fujita M, Abe K, Takahashi A, Muto M, Ishigame T, Okada R, Marubashi S, Ohira H. Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver. Intern Med 2021; 60:235-240. [PMID: 32893230 PMCID: PMC7872811 DOI: 10.2169/internalmedicine.5166-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 45-year-old woman with abdominal pain after minor trauma was referred to our hospital. Computed tomography (CT) showed a hypovascular tumor in the left liver lobe. A tumor biopsy revealed granuloma, although no findings indicated malignancy or infection. A follow-up imaging study showed spread of the hepatic tumor. Her abdominal pain worsened after a second minor trauma. CT revealed an intratumor abscess, and pus overflowed from the patient's umbilicus. The abscess was improved by antibiotics and drainage therapy. In this case, unusual imaging findings and an atypical disease course of a hepatic inflammatory pseudotumor were observed.
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Affiliation(s)
- Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Makoto Muto
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
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Navin PJ, Olson MC, Knudsen JM, Venkatesh SK. Elastography in the evaluation of liver allograft. Abdom Radiol (NY) 2021; 46:96-110. [PMID: 31950204 DOI: 10.1007/s00261-019-02400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Elastography is an established technique in the evaluation of chronic liver diseases. While there is a large clinical experience and data available regarding the performance of elastography in native liver, elastography experience with liver grafts is limited and still growing. Both ultrasound-based elastography techniques and MR Elastography (MRE) are useful in the assessment of liver fibrosis in liver transplants. Technical modifications for performing elastography will be required for optimum evaluation of the graft. In general, caution needs to be exercised regarding the use of elastography immediately following transplantation as post-operative changes, perioperative conditions/complications, inflammation, and rejection can cause increased stiffness in the graft. In the follow-up, detection of increased stiffness with elastography is useful for predicting development of fibrosis in the graft. Adjunctive MRI or ultrasound with Doppler also provides comprehensive evaluation of anatomy, vascular anastomosis and patency, biliary tree, and stiffness for fibrosis. In this review, we provide a brief overview of elastography techniques available followed by the literature review of elastography in the evaluation of grafts and illustration with clinical examples.
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Ateş ÖF, Taydaş O, Kara AB, Göktepeli M, Özdemir M. A new predictor of bleeding based on ultrasonographic features in percutaneous liver mass biopsy. Turk J Med Sci 2020; 50:1970-1975. [PMID: 33078606 PMCID: PMC7775694 DOI: 10.3906/sag-2005-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/20/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim An ultrasound-guided liver mass biopsy is a method frequently used in determining the diagnosis and treatment plan.The aim of this study was to evaluate the potential new predictors of bleedingbased on ultrasonographic features in liver mass biopsies, which are frequently applied in routine clinical practice. Materials and methods The images and data of patients aged over 18years,who underwent an imaging-guided percutaneous liver mass biopsy between January 2018 and December 2019 with various indications, were retrospectively reviewed. Liver size, liver steatosis status, parenchyma appearance, and mass vascularity on Doppler ultrasonography before the procedure, and hemoglobin (Hb) values before and after the procedure were recorded. Results A total of 176 patients were included in the study. Ninety-six patients were male (54.5%) and 80 were female (45.5%). The mean age of the patients was 64 ± 12.3 years. The mean hemoglobin values of the patients were 11.5 ± 1.9 gr/dL before the procedure and 11.4 ± 1.5 gr/dL after the procedure. While 144 of the patients had less than 10% hemoglobin decrease (81.8%), 32 had more than 10% decrease (8.2%). In 56 patients, a heterogeneous and coarse granular pattern was observed in the liver parenchyma (31.8%). The decrease in the Hb rate was significantly higher in patients with heterogeneous and coarse granular liver parenchyma (8.7%) than in patients with normal parenchyma (6.6%) (P = 0.036). Conclusion In our study, it was shown for the first time in the literature that the ultrasonographic appearance of the liver (heterogeneous and coarse granular parenchyma) may also be one of the parameters that can help to predict the risk of bleeding.
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Affiliation(s)
- Ömer Faruk Ateş
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Onur Taydaş
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmet Burak Kara
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Göktepeli
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mustafa Özdemir
- Department of Radiology, Kayseri City Hospital, Kayseri, Turkey
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Hemorrhagic shock necessitating resuscitation and damage control surgery after needle biopsy: A report of two cases. Trauma Case Rep 2020; 31:100389. [PMID: 33385057 PMCID: PMC7770969 DOI: 10.1016/j.tcr.2020.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Percutaneous needle biopsy is minimally invasive and widely performed. Bleeding is an important complication of needle biopsy. Because the wound created by the needle is small, the recognition of bleeding in the body may be delayed, and this delay can lead to hemorrhagic shock and death. We report two cases of hemorrhagic shock in which the trauma triad of death developed after needle biopsy and the patients required resuscitation and damage control surgery. Needle biopsy is less invasive but cannot stop bleeding, and so surgery should be considered to ensure hemostasis in a compromised patient.
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McClure T, Goh SK, Cox D, Muralidharan V, Dobrovic A, Testro AG. Donor-specific cell-free DNA as a biomarker in liver transplantation: A review. World J Transplant 2020; 10:307-319. [PMID: 33312892 PMCID: PMC7708879 DOI: 10.5500/wjt.v10.i11.307] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/09/2020] [Accepted: 10/30/2020] [Indexed: 02/05/2023] Open
Abstract
Due to advances in modern medicine, liver transplantation has revolutionised the prognosis of many previously incurable liver diseases. This progress has largely been due to advances in immunosuppressant therapy. However, despite the judicious use of immunosuppression, many liver transplant recipients still experience complications such as rejection, which necessitates diagnosis via invasive liver biopsy. There is a clear need for novel, minimally-invasive tests to optimise immunosuppression and improve patient outcomes. An emerging biomarker in this ''precision medicine'' liver transplantation field is that of donor-specific cell free DNA. In this review, we detail the background and methods of detecting this biomarker, examine its utility in liver transplantation and discuss future research directions that may be most impactful.
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Affiliation(s)
- Tess McClure
- Liver Transplant Unit, Austin Health, Heidelberg 3084, VIC, Australia
| | - Su Kah Goh
- Department of Surgery, Austin Health, Heidelberg 3084, VIC, Australia
| | - Daniel Cox
- Department of Surgery, Austin Health, Heidelberg 3084, VIC, Australia
| | | | - Alexander Dobrovic
- Department of Surgery, The University of Melbourne, Heidelberg 3084, VIC, Australia
| | - Adam G Testro
- Liver Transplant Unit, Austin Health, Heidelberg 3084, VIC, Australia
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Varela-Ponte R, Martínez-Lago N, Vieito-Villar M, Carreira-Villamor JM. Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2020; 64:S0033-8338(20)30141-7. [PMID: 33257053 DOI: 10.1016/j.rx.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/30/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ultrasound-guided percutaneous liver biopsy is considered the technique of choice for the histological diagnosis of space-occupying lesions, given its high level of safety and diagnostic performance. However, since it is an invasive diagnostic procedure, complications can occur. Various clinical and radiological parameters have been analyzed as factors related with the efficacy of the technique or with its complications; however, the results have been contradictory. Thus, we aimed to evaluate the impact of various risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy in the diagnosis of space-occupying lesions in ordinary clinical practice. MATERIAL AND METHODS This retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analyzed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin > 100mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analyzed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analyzed in terms of the percentage of complications, which were classified as major or minor. RESULTS We included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalized patients, and 65% of the lesions were located in the right liver lobe. The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (p=0.04). CONCLUSIONS Ultrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.
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Affiliation(s)
- R Varela-Ponte
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España.
| | - N Martínez-Lago
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Vieito-Villar
- Unidad de Sacorma y Neuroncología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - J Martin Carreira-Villamor
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
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Bourhis H, Gerbes AL, Op den Winkel M, Denk G. [Elevated liver enzymes]. MMW Fortschr Med 2020; 162:59-67. [PMID: 33164192 DOI: 10.1007/s15006-020-4404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Hélène Bourhis
- Ludwig-Maximilians-Universität, Medizinische Klinik und Poliklinik II, München, Germany.
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Reece J, Pavlick M, Penninck DG, Webster CRL. Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs. J Vet Intern Med 2020; 34:2398-2404. [PMID: 33125175 PMCID: PMC7694835 DOI: 10.1111/jvim.15942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).
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Affiliation(s)
- Jonjo Reece
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Michelle Pavlick
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Dominique G Penninck
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
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Keerl C, Bernsmeier C. [Elevated liver function tests - as incidental finding in general practice]. Ther Umsch 2020; 77:371-378. [PMID: 33054645 DOI: 10.1024/0040-5930/a001206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Elevated liver function tests - as incidental finding in general practice Abstract. In general practice, elevated liver function tests are found in 25 % of patients presenting with unspecific symptoms or during a routine health checkup. Approximately 2.5 % of the general population are expected to show elevated values. Conversely, liver disease can present without abnormal liver function tests. Liver disease is not only frequent but may also imply a significant mortality. Worldwide its prevalence is steadily rising, and liver disease has become the fifth leading cause of death. Responsible for the rapidly increasing prevalence are primarily non-alcoholic fatty liver disease (NAFLD), alcohol-related liver disease (ARLD) and viral hepatitis. Due to the large range of possible differential diagnoses and the coexistence of aetiologies liver diseases represent a diagnostic challenge with important prognostic implication. In case of elevated liver function, a detailed medical history and a thorough clinical examination should be performed first. This allows narrowing down possible causes to the few most likely differential diagnoses. Subsequently, depending on the level of elevated liver function and the clinical presentation as hepatitis or cholestasis, screening tests for differential liver diseases are performed. Laboratory diagnostics and obligatory ultrasound scan can be supplemented by non-invasive methods (e. g. elastography, MRI / MRCP / CT) and in selected cases invasive methods (liver biopsy, ERCP). In the following article we delineate the diagnostic approach to elevated liver function tests using algorithms.
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Affiliation(s)
- Claudia Keerl
- Gastroenterologie und Hepatologie, Clarunis Universitäres Bauchzentrum Basel, St. Claraspital und Universitätsspital Basel.,Claudia Keerl und Christine Bernsmeier haben in gleichem Masse zum Manuskript beigetragen
| | - Christine Bernsmeier
- Gastroenterologie und Hepatologie, Clarunis Universitäres Bauchzentrum Basel, St. Claraspital und Universitätsspital Basel.,Claudia Keerl und Christine Bernsmeier haben in gleichem Masse zum Manuskript beigetragen
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Baran B, Kale S, Patil P, Kannadath B, Ramireddy S, Badillo R, DaVee RT, Thosani N. Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis. Surg Endosc 2020; 35:5546-5557. [PMID: 33052529 DOI: 10.1007/s00464-020-08053-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver samples for diagnosis of liver parenchymal diseases. There are studies that have evaluated the feasibility and safety of EUS-guided parenchymal liver biopsy (EUS-LB), however, factors that can influence specimen quality are yet to be determined. Our aim was to determine the diagnostic accuracy of EUS-LB and evaluate factors associated with specimen quality. METHODS We performed a detailed search of PubMed/MEDLINE and Web of Science™ databases to identify studies in which results of EUS-guided liver parenchymal biopsies were reported published up to July 2020. A random effects model was used to estimate pooled values (mean ± SE) for total specimen length (TSL) and complete portal tracts (CPT). Subgroup analyses were applied to find out the procedural factors associated with better specimen quality using Cochran's Q test. A total of 10 meta-analyses were done focusing on international studies. Total of 1326 patients who underwent EUS-LB. EUS-LBs performed for suspicion of parenchymal liver disease. Pooled mean values for TSL and CPT with subgroup analyses. RESULTS Twenty-three studies with a total of 1326 patients were included in our meta-analysis. Overall pooled mean TSL and CPT were 45.3 ± 4.6 mm and 15.8 ± 1.5, respectively. In subgroup analysis, core biopsy needles proved to better in terms of CPT than fine-needle aspiration needles (18.4 vs 10.99, p = 0.003). FNB with slow-pull or suction technique provided a similar TSL (44.3 vs 53.9 mm, p = 0.40), however, slow-pull technique was better in terms of CPT (30 vs 14.6, p < 0.001). Heterogeneity was present among the studies. Another limitation is the low number randomized control trials. CONCLUSION EUS-guided parenchymal liver biopsy is a good alternative to other methods of liver sampling. Using FNB needles with a slow-pull technique can provide better results.
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Affiliation(s)
- Bulent Baran
- Koc University School of Medicine, Istanbul, Turkey
| | - Santosh Kale
- Nassau University Medical Center, East Meadow, NY, USA
| | - Prithvi Patil
- UTHealth McGovern Medical School, Houston, TX, USA.,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA
| | - Bijun Kannadath
- University of Arizona, Tucson, AZ, USA.,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA
| | - Srinivas Ramireddy
- UTHealth McGovern Medical School, Houston, TX, USA.,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA
| | - Ricardo Badillo
- UTHealth McGovern Medical School, Houston, TX, USA.,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA
| | - Roy Tomas DaVee
- UTHealth McGovern Medical School, Houston, TX, USA.,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA
| | - Nirav Thosani
- UTHealth McGovern Medical School, Houston, TX, USA. .,Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA.
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Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, Hubscher S, Karkhanis S, Lester W, Roslund N, West R, Wyatt JI, Heydtmann M. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69:1382-1403. [PMID: 32467090 PMCID: PMC7398479 DOI: 10.1136/gutjnl-2020-321299] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.
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Affiliation(s)
- James Neuberger
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jai Patel
- Department of Vascular Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Caldwell
- Liver Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Susan Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stefan Hubscher
- Department of Pathology, University of Birmingham, Birmingham, UK
| | - Salil Karkhanis
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Judith I Wyatt
- Department of Pathology, St James University Hospital, Leeds, UK
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital, Glasgow, UK
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