Fuat Ekiz1, İlhami Yuksel2, Ata Turker Arikök3, Baris Yilmaz4, Akif Altinbas5, Bora Aktas6, Murat Deveci7, Omer Basar8, Sahin Coban9, Osman Yuksel8. 1. Department of Gastroenterology, Hatay Antakya State Hospital, Saraykent mh. 20.sk, Antakya, Hatay, Turkey. dr_ekiz@yahoo.com. 2. Department of Gastroenterology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey. 3. Department of Pathology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey. 4. Department of Gastroenterology, Osmaniye State Hospital, Osmaniye, Turkey. 5. Department of Gastroenterology, Ankara Numune Educational and Research Hospital, Ankara, Turkey. 6. Department of Gastroenterology, Ankara Kecioren Educational and Research Hospital, Ankara, Turkey. 7. Department of Gastroenterology, Yozgat State Hospital, Yozgat, Turkey. 8. Department of Gastroenterology, School of Medicine, Hacettepe University, Ankara, Turkey. 9. Department of Gastroenterology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey.
Abstract
BACKGROUND AND AIM: Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B. PATIENTS AND METHODS: 27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system. RESULTS: Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found. CONCLUSIONS: With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.
BACKGROUND AND AIM: Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B. PATIENTS AND METHODS: 27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system. RESULTS: Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found. CONCLUSIONS: With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis Bpatients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.