Histologic variation of grade and stage of nonalcoholic fatty liver disease in liver biopsies
Histologic variation of grade and stage of nonalcoholic fatty liver disease in liver biopsies
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DOI：
10.1381/0960892053723268
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发表时间：
2005-04-01
期刊：
影响因子：
2.9
通讯作者：
Blaszyk, H
中科院分区：
文献类型：
--
作者：
Janiec, DJ;Jacobson, ER;Blaszyk, H
背景：关于疾病分级和分期的采样错误已被归因于慢性肝病患者的肝穿刺活检。虽然有几项研究评估了肝活检的采样误差，但没有一项研究在非酒精性脂肪性肝病（NAFLD）患者中研究这种现象。本研究alms以确定从接受Roux-en-Y胃旁路术（RYGBP）手术病态obesity.Methods：10例病态肥胖患者同时进行肝活检，从右肝叶和左肝叶在开放式检查前的RYGBP程序中获得的肝活检的采样误差率和程度。随后随机评价活检，然后由肝脏病理学家盲法重新评价。炎症活动度和纤维化程度进行了测定，并为每个样本使用半定量系统与3级和4 stages.Results评分：没有分级差异进行观察，3例（30%）有至少1个阶段之间的差异，右叶和左叶。1例患者在配对样本中存在2期差异，活检尺寸和汇管区数量显著不同。盲法组织学重新评估并没有导致分级或分期分数，从原来的evaluation.Conclusions不同：从右肝叶和左肝叶的肝活检样本显示出类似的疾病活动度等级，但不同的组织病理学分期在30%的NAFLD患者。获得足够大小的活检组织（长度> 1.0 cm，汇管区> 10）可大大降低采样误差。
Background: Sampling error regarding disease grade and stage has been ascribed to needle liver biopsies in patients with chronic liver disease. Although several studies evaluating sampling error in liver biopsies exist, none have investigated this phenomenon in patients with non-alcoholic fatty liver disease (NAFLD). This study alms to determine the rate and extent of sampling error in liver biopsies obtained from patients undergoing Roux-en-Y gastric bypass (RYGBP) surgery for morbid obesity.Methods: 10 morbidly obese patients underwent simultaneous liver biopsies from the right and left hepatic lobes during an open examination preceding the RYGBP procedure. The biopsies were subsequently randomly evaluated and then blindly re-evaluated by a liver pathologist. Degrees of inflammatory activity and fibrosis were determined and scored for each sample using a semi-quantitative system with 3 grades and 4 stages.Results: No grading differences were observed, and 3 patients (30%) had a difference of at least 1 stage between the right and left lobes. One patient had a 2-stage difference in paired samples, with significantly different biopsy sizes and number of portal tracts. Blinded histologic re-evaluation did not result in grading or staging scores that differed from the original evaluation.Conclusions: Liver biopsy samples taken from the right and left hepatic lobes showed similar grades of disease activity, but differed in histopathologic staging in 30% of the NAFLD patients. Obtaining an adequately sized biopsy (> 1.0 cm in length with > 10 portal tracts) greatly reduces sampling error.