Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?
Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?
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DOI：
10.1136/gut.2010.214650
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发表时间：
2010-07-01
期刊：
影响因子：
24.5
通讯作者：
Pinzani, Massimo
中科院分区：
文献类型：
--
作者：
Castera, Laurent;Pinzani, Massimo
肝活检与“金标准”之辩肝病学作为一门明确的临床学科的诞生恰逢20世纪50年代末孟吉尼针的引入。当时，人们对肝病的病因知之甚少，大多数患者的诊断主要基于活检获得的肝脏标本的形态学检查。坏死、炎症和纤维化等特征没有精确分类，最终的标签仅仅是描述，即慢性持续性、慢性活动性肝炎和肝硬化。在这些方面，肝活检是唯一可用的诊断手段，真正代表了金标准。所谓的“一秒钟肝穿刺活检”的引入，从一开始就以临床医生和病理学家之间的重要合作为特征。临床肝病学家接受肝脏病理学培训，这导致了欧洲和美国肝病学主要学术流派的基础。评分系统的引入代表了肝活检的使用向前迈进了一步。这一介绍暗示了在肝活检标本的评估中需要更精确，这超出了描述，在许多情况下，病理学家的意见。总的来说，评分系统的引入是为了促进样本之间的比较，并根据全球协议交流结果。然而，这个明显的优势，一旦被统计研究分析，就开始受到批评
LIVER BIOPSY AND THE ‘GOLD STANDARD’DEBATE The birth of Hepatology as a defined clinical discipline coincides with the introduction of Menghini’s needle in the late 1950s. 1 In those days, very little was known about the aetiology of liver disease and in the majority of patients diagnosis was mainly based on the morphological examination of liver specimens obtained with a biopsy. Features such as necrosis, inflammation and fibrosis were not precisely categorised, and the final label was merely descriptivedthat is, chronic persistent, chronic active hepatitis and cirrhosis. In these terms, liver biopsy was the only available diagnostic means, and truly represented a gold standard. The introduction of the so-called ‘one second needle biopsy of the liver’was characterised since the beginning by a significant cooperative effort between the clinician and the pathologist. Clinical hepatologists were trained in liver pathology and this led to the foundation of the main academic schools of Hepatology in Europe and the USA.The introduction of scoring systems represented a step forward in the use of liver biopsy. This introduction implied the necessity for more precision in the evaluation of liver biopsy specimens that was beyond the description and, in many instances, the opinion of the pathologist. Overall, the introduction of scoring systems was supposed to facilitate the comparison between samples and the communication of the results according to a global agreement. However, this obvious advantage, once analysed by statistical studies, started to be criticised in term of