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
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
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DOI：
10.1136/gutjnl-2020-321299
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发表时间：
2020-08-01
期刊：
影响因子：
24.5
通讯作者：
Heydtmann, Mathis
中科院分区：
文献类型：
--
作者：
Neuberger, James;Patel, Jai;Heydtmann, Mathis
当无法通过更安全的方法获得有关患者诊断、预后或管理的临床重要信息时，或出于研究目的，需要进行肝活检。肝活检有几种方法，但主要采用经皮或经静脉方法。有多种活检针可供选择，使用的穿刺方法和类型取决于患者的临床状态和当地专业知识，但对于非病变活检，建议使用16号活检针。许多肝病患者会有异常的实验室凝血试验或接受抗凝或抗血小板药物治疗。更好地了解肝脏疾病的止血变化，可以更合理地采用循证方法进行围活检期管理。总体而言，肝活检是安全的，但发病率和死亡率很低，因此必须对患者进行充分的咨询。标本必须具有足够的大小以进行组织病理学解释。与组织病理学家沟通，获得相关的临床信息和其他研究的结果，是生成临床有用的报告的关键。
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.