Report 19 from Dallas 50th AASLD Meeting, Nov 5-9

Potential for Liver Biopsy Sampling Error
Jules Levin, NATAP

summary: this study suggests that performing a single biopsy taken in right lobe of liver may lead to sampling error and different diagnosis than when taking a second biopsy from left lobe in liver.

SAMPLING ERROR ASSOCIATED WITH A NEEDLE LIVER BIOPSY IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION 

Arie Regev, Univ of Miami School of Medicine, Miami, FL; Mariana Berho, Dept of Pathology, U of Miami School of Medicine, Miami, FL; Lennox J Jeffers, Ctr for Liver Diseases & VAMC, Miami, FL; Milikowski Clara, Dept of Pathology,, Miami, FL; Guy W Neff, Francisco Civantos, Nikolaos Pyrsopoulos, Ctr for Liver Diseases, U of Miami School of Medicine, Miami, FL; Fawad Ahmed, Ctr for Liver Diseases, Miami, FL; Leticia P Luz, Zhen-Zhou Feng, Univ of Miami School of Medicine, Miami; Enrique G Molina, K Rajender Reddy, Ctr for Liver Diseases, U of Miami School of Medicine, Miami, FL

Background: Needle liver biopsy has been shown in previous studies to be associated with a high rate of sampling error in pts with diffuse parenchymal liver diseases. To determine the rate and extent of sampling error in pts with chronic hepatitis C, we performed simultaneous needle biopsies of the right (Rt) and left (Lt) hepatic lobes in HCV pts. Patients and Methods: 124 pts with chronic HCV infection underwent laparoscopy guided biopsies of the Lt and Rt hepatic lobes. Formalin fixed paraffin embedded sections were stained with Hematoxylin and Eosin and with Trichrome. The slides were blindly coded and reviewed in a random order by two liver pathologists. The histological findings were graded according to the standard grading and staging method described by Batts and Ludwig. Following the interpretation, the slides were uncoded to compare the results of the Rt and Lt lobes. 50 of the samples were blindly resubmitted for examination to determine the intra-observer variance. 

Results: 30 pts (24.2%) had a difference of at least 1 grade and 41 pts (33.1%) had a difference of at least 1 stage between the Rt and Lt lobes. In 18 pts (14.5%) cirrhosis was diagnosed in one lobe while grade 3 fibrosis was diagnosed in the other. A difference of 2 stages or 2 grades was found in only 3 (2.4%) and 2 (1.6%) pts respectively. Of the 50 samples that were examined twice, the grading by each pathologist on the second examination differed from the first examination in 0% and 5%, and the staging differed in 7% and 10% respectively. 

Conclusions: Liver biopsy samples taken from the Rt and Lt hepatic lobes differ in grading and staging in a large proportion of HCV patients. Sampling error may lead to underdiagnosis of cirrhosis in 14.5% of the patients. These differences cannot be attributed to intra-observer variance.