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Liu S, Han Y, Kong L, Wang G, Ye Z. Atomic force microscopy in disease-related studies: Exploring tissue and cell mechanics. Microsc Res Tech 2024; 87:660-684. [PMID: 38063315 DOI: 10.1002/jemt.24471] [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: 07/30/2023] [Revised: 10/22/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Despite significant progress in human medicine, certain diseases remain challenging to promptly diagnose and treat. Hence, the imperative lies in the development of more exhaustive criteria and tools. Tissue and cellular mechanics exhibit distinctive traits in both normal and pathological states, suggesting that "force" represents a promising and distinctive target for disease diagnosis and treatment. Atomic force microscopy (AFM) holds great promise as a prospective clinical medical device due to its capability to concurrently assess surface morphology and mechanical characteristics of biological specimens within a physiological setting. This review presents a comprehensive examination of the operational principles of AFM and diverse mechanical models, focusing on its applications in investigating tissue and cellular mechanics associated with prevalent diseases. The findings from these studies lay a solid groundwork for potential clinical implementations of AFM. RESEARCH HIGHLIGHTS: By examining the surface morphology and assessing tissue and cellular mechanics of biological specimens in a physiological setting, AFM shows promise as a clinical device to diagnose and treat challenging diseases.
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Affiliation(s)
- Shuaiyuan Liu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
| | - Yibo Han
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
| | - Lingwen Kong
- Department of Cardiothoracic Surgery, Central Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
- JinFeng Laboratory, Chongqing, China
| | - Zhiyi Ye
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
- JinFeng Laboratory, Chongqing, China
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Niriella MA, Kanagarajah D, De Silva Hewavisenthi J, de Silva HJ. Mistakes in utilising histopathology for the management of liver disease. Expert Rev Gastroenterol Hepatol 2024; 18:147-153. [PMID: 38743469 DOI: 10.1080/17474124.2024.2355168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Liver biopsy has become selective due to its invasiveness, potential adverse effects, patient acceptance and cost. Furthermore, the emergence of noninvasive tests (NITs) has challenged the necessity of liver biopsies in specific clinical situations. However, liver biopsy continues to play a crucial role in disease diagnosis, prognosis, and evaluating treatment compliance and response in selected patients. AREAS COVERED In this narrative review, we discuss the errors and the shortcomings that can occur at various stages, from the initial patient selection for a liver biopsy to the final reporting phase, and strategies to address them. Clinicians and pathologists must take all necessary precautions to mitigate potential shortcomings that could compromise the value of liver biopsies. EXPERT OPINION The increasing sophistication of NITs offers a safer, more convenient, and potentially more cost-effective approach to diagnosing chronic liver disease, especially for assessing the degree of liver fibrosis. As NITs continue to evolve, liver biopsy will likely transition to a more targeted role, ensuring optimal patient care in the ever-changing field of hepatology. However, liver biopsy will continue to have a pivotal role in assessing acute liver disease where the diagnostic yield of the liver biopsy still outweighs that of NITs.
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Affiliation(s)
- Madunil Anuk Niriella
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Dharani Kanagarajah
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | | | - H Janka de Silva
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
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3
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Neuberger J, Cain O. The Need for Alternatives to Liver Biopsies: Non-Invasive Analytics and Diagnostics. Hepat Med 2021; 13:59-69. [PMID: 34163263 PMCID: PMC8214024 DOI: 10.2147/hmer.s278076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Histology remains essential for the diagnosis and management of many disorders affecting the liver. However, the biopsy procedure itself is associated with a low risk of harm to the patient and cost to the health services; samples may not be adequate and are subject to sampling variation. Furthermore, interpretation often depends on the skill of the pathologist. Increasingly, new techniques are becoming available that are altering the indications for liver biopsy. Many diseases of the liver can be diagnosed and managed using serological and radiological techniques; the degree of fibrosis and fat can often be assessed by serological or imaging techniques and the nature of space occupying lesions defined by serology, imaging and use of liquid biopsy. However, these techniques, too, are subject to limitations: sensitivity and specificity is not always adequate for diagnosis or management; some techniques are expensive and often also require expert interpretation. Although there may be less need for liver biopsy today, histology remains the gold standard as well as an essential tool for the diagnosis and management of many conditions, especially where there are multiple pathologies, or where a diagnosis cannot or has not been made by alternative approaches. Until less invasive techniques become more reliable and accessible, liver histology will remain a key investigation.
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Affiliation(s)
- James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - Owen Cain
- Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
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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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5
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Yue SYP, Lucas SB, Brown M, Chiodini PL, Walker SL, Mahadeva U. Utility of an infectious and tropical disease histopathology diagnostic review service. J Clin Pathol 2020; 73:836-839. [PMID: 32576629 DOI: 10.1136/jclinpath-2020-206546] [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: 02/29/2020] [Revised: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Abstract
AIM To assess the utility of a London-based infectious and tropical disease histopathology diagnostic review service. METHODS The original and specialist review histopathology reports of 457 samples from over 3 years of referrals were compared retrospectively. RESULTS Overall 329 (72.0%) showed no significant difference; 34 (7.4%) showed a non-clinically significant difference; and 94 (20.6%) showed a clinically significant difference. Of the 94 clinically significant discrepancies, 46 (48.9%) were incorrectly suspected infections; 19 (20.2%) were missed infections; 8 (8.5%) were different infections; and in 20 (21.3%), the specialist review yielded more specific identification of an organism or a more correct assessment of its viability. CONCLUSIONS A review of histopathology cases by an infectious disease (ID) histopathology referral centre has yielded a 20.6% clinically significant error rate. Measures to improve training in ID histopathology in the UK are discussed.
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Affiliation(s)
- Sum Yu Pansy Yue
- Department of Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Sebastian B Lucas
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Histopathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter L Chiodini
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen L Walker
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ula Mahadeva
- Faculty of Life Sciences and Medicine, King's College London, London, UK .,Department of Histopathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Interpretation of core biopsy of liver mass lesions: A comparison study between cytopathologist and gastrointestinal pathologist. Ann Diagn Pathol 2019; 40:152-160. [DOI: 10.1016/j.anndiagpath.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/21/2022]
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7
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Rassam F, Olthof PB, Takkenberg BR, Beuers U, Klümpen HJ, Bennink RJ, van Lienden KP, Besselink MG, Busch OR, Verheij J, van Gulik TM. Scintigraphic liver function and transient elastography in the assessment of patients with resectable hepatocellular carcinoma. HPB (Oxford) 2019; 21:626-635. [PMID: 30366883 DOI: 10.1016/j.hpb.2018.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/16/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatobiliary scintigraphy (HBS) is used to quantify total and regional liver function. Transient elastography (TE) provides a non-invasive alternative to percutaneous biopsy to assess liver fibrosis and cirrhosis. This study aims to determine the correlation between HBS and histopathology of liver parenchyma, and to compare these with TE in patients with resectable hepatocellular carcinoma (HCC). METHODS Patients who underwent surgery for HCC between 2000 and 2016 after preoperative HBS were included. Non-tumorous liver tissue was evaluated for inflammation, steatosis, ballooning, siderosis and fibrosis. Correlation analysis was performed between HBS results and histopathological scoring. These were also compared with TE and surgical outcomes. RESULTS 71 patients underwent preoperative HBS of whom 24 also had TE. HBS correlated with portal and lobular inflammation as well as fibrosis. TE correlated with portal and lobular inflammation, ballooning and fibrosis. A significant correlation was found between HBS and TE. No association was found with overall postoperative morbidity and mortality. CONCLUSION HBS and TE show a moderate to strong correlation. HBS and TE share discriminatory features of histopathological scoring and show a weak to moderate correlation with hepatic inflammation and fibrosis.
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Affiliation(s)
- Fadi Rassam
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands.
| | - Pim B Olthof
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Bart R Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Roelof J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Krijn P van Lienden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
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Torbenson MS, Arnold CA, Graham RP, Jain D, Kakar S, Lam-Himlin DM, Naini BV, Wu TT, Yeh M. Identification of key challenges in liver pathology: data from a multicenter study of extramural consults. Hum Pathol 2019; 87:75-82. [PMID: 30857968 DOI: 10.1016/j.humpath.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/01/2019] [Accepted: 02/24/2019] [Indexed: 11/25/2022]
Abstract
Extramural consultation for challenging pathology cases is an important part of patient care. The specific reasons why liver cases are submitted in consultation are poorly understood. To study patterns in extramural consultation, data were gathered from 1360 liver/GI/pancreatobiliary consults submitted to 7 academic centers. Liver cases comprised 40% of consults and are the focus of this paper. They were submitted for questions on medical (61%) and tumor pathology (39%). A preliminary diagnosis was provided by the referring pathologist in 65% of cases. The most common questions in medical liver pathology were on general classification of a hepatitic pattern of injury (37%), primary biliary cirrhosis (14%), fatty liver disease (13%), autoimmune hepatitis (12%), and etiology of cirrhosis (10%). Most tumor consults were submitted for classification (83%). The most common final tumor consultant diagnoses for benign tumors were hepatic adenoma or focal nodular hyperplasia (52%) and for malignant tumors were metastatic malignancies (47%), hepatocellular carcinoma (32%), or cholangiocarcinoma (8%). For cases submitted with a diagnosis of malignancy, the diagnosis was concordant (43% of cases), concordant but with a generic diagnosis for which a more specific diagnosis could be rendered (37%), or discordant with a major change in diagnosis from malignant to benign or change in tumor type (17%). In conclusion, analysis of consult patterns identifies challenging areas in medical and tumor liver pathology, areas that benefit from consult services and can be focused on by continuing medical educational activities.
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Affiliation(s)
- Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA.
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Dora M Lam-Himlin
- Department of Pathology and Laboratory Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Bita V Naini
- Department of Laboratory Medicine and Pathology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Matthew Yeh
- Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
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9
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Bashir MR, Chernyak V. Can MRI Features of Combined Hepatocellular Carcinoma-Intrahepatic Cholangiogarcinoma Help Predict Tumor Behavior Better than Histologic Findings? Radiology 2018; 290:398-399. [PMID: 30422087 DOI: 10.1148/radiol.2018182408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mustafa R Bashir
- Form the Department of Radiology, Center for Advanced Magnetic Resonance Development, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 (M.R.B.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Victoria Chernyak
- Form the Department of Radiology, Center for Advanced Magnetic Resonance Development, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 (M.R.B.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
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10
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Butel R, Davies SE, Paterson A, Sams V, Tsigka A, Sington JD. A specialist liver clinical pathological conference at a non-transplant centre: a potential model for improving discrepancy rates. Histopathology 2018; 73:534-535. [PMID: 29672915 DOI: 10.1111/his.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan Butel
- Cellular Pathology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Susan E Davies
- Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anna Paterson
- Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Virginia Sams
- Cellular Pathology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Alexia Tsigka
- Cellular Pathology, Norfolk and Norwich University Hospital, Norwich, UK
| | - James D Sington
- Cellular Pathology, Norfolk and Norwich University Hospital, Norwich, UK
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Horvath B, Allende D, Xie H, Guirguis J, Jeung J, Lapinski J, Patil D, McCullough AJ, Dasarathy S, Liu X. Interobserver Variability in Scoring Liver Biopsies with a Diagnosis of Alcoholic Hepatitis. Alcohol Clin Exp Res 2017; 41:1568-1573. [PMID: 28654190 DOI: 10.1111/acer.13438] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/12/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alcoholic hepatitis (AH) is one of the most severe forms of alcoholic liver disease. Recently, a histologic scoring system for predicting prognosis in this patient cohort was proposed as Alcoholic Hepatitis Histologic Score (AHHS). We aimed to assess interobserver variability in recognizing histologic features of AH and the effect of this variability on the proposed AHHS categories. METHODS Hematoxylin-eosin- and trichrome-stained slides from 32 patients diagnosed with AH with liver biopsies within 1 month of presentation (2000 to 2015) were reviewed by 5 pathologists including 3 liver pathologists and 2 gastrointestinal (GI) pathologists masked to the clinical findings or outcome. Histologic features of AH were assessed, the AHHS was calculated, and an AHHS category (mild, moderate, severe) was assigned. The Fleiss' kappa coefficient (κ) analysis was performed to determine the interobserver agreement. RESULTS A slight-to-moderate level of interobserver agreement existed among 5 reviewers on histopathologic features of AH with κ value ranging from 0.20 (95% confidence interval (CI): 0.03 to 0.46, megamitochondria) to 0.52 [95% CI: 0.40 to 0.68, polymorphonuclear leukocyte (PMN) infiltration]. There was only a fair level of agreement in assigning AHHS category (κ = 0.33, 95% CI: 0.20 to 0.51). While overall fibrosis and neutrophilic inflammation were comparably evaluated by 3 liver pathologists and 2 GI pathologists, bilirubinostasis and megamitochondria were more consistently diagnosed by liver pathologists. Overall, 18 of 32 (56%) were uniformly assigned to an AHHS category by all liver pathologists with a κ value of 0.40 (95% CI: 0.22 to 0.60). CONCLUSIONS In general, features of AH can be recognized with a slight-to-moderate level of interobserver agreement and there was fair interobserver agreement on assigning an AHHS category. Significant interobserver variability among pathologists revealed by the current study can limit its usefulness in everyday clinical practice.
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Affiliation(s)
- Bela Horvath
- Department of Anatomic Pathology , Cleveland Clinic, Cleveland, Ohio
| | - Daniela Allende
- Department of Anatomic Pathology , Cleveland Clinic, Cleveland, Ohio
| | - Hao Xie
- Department of Medicine , Yale University, New Haven, Connecticut
| | - John Guirguis
- Department of Gastroenterology and Hepatology , Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Jeung
- Department of Anatomic Pathology , Cleveland Clinic, Cleveland, Ohio
| | - James Lapinski
- Department of Anatomic Pathology , Cleveland Clinic, Cleveland, Ohio
| | - Deepa Patil
- Department of Anatomic Pathology , Cleveland Clinic, Cleveland, Ohio
| | - Arthur J McCullough
- Department of Gastroenterology and Hepatology , Cleveland Clinic, Cleveland, Ohio
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology , Cleveland Clinic, Cleveland, Ohio
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine , University of Florida, Gainesville, Florida
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Abstract
Histopathologic evaluation of liver biopsy specimens yields information that is not otherwise obtainable and is frequently essential for diagnosing hepatic disease. Percutaneous needle biopsy, laparoscopic biopsy, and surgical biopsy each have their own set of advantages and disadvantages. Care should be taken to ensure an adequate amount of tissue is collected for meaningful histologic evaluation. Because sampling error is a limitation of hepatic biopsy, multiple liver lobes should be biopsied. This article discusses the indications for liver biopsy, associated risks, advantages and disadvantages of different biopsy techniques, and strategies to get the most useful information possible out of this process.
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Affiliation(s)
- Jonathan A Lidbury
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843, USA.
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