Does Size Matter? – Assessing the Adequacy of Core Biopsies for Medical Liver Diseases
Eve Fryer, Lai Mun Wang, Clare Verrill, Ken Fleming. John Radcliffe Hospital, Oxford, United Kingdom
Background: Core biopsy is a key tool in diagnosis and staging of many medical liver diseases. There are concerns that the small size of the specimen obtained and the patchy nature of many of these diseases may result in misdiagnosis or inaccurate staging. In the United Kingdom, the Royal College of Pathologists has issued guidelines for minimum (at least 10 mm in length and 6 portal tracts) and optimum (at least 20 mm in length and 11 portal tracts) sizes. We performed a retrospective review of our cases over the last 15 years to assess our compliance with this guideline and the outcome of technically inadequate specimens.
Design: All core biopsies performed for medical liver diseases reported between January 1997 and December 2011 were identified using our pathology report archive and the search term “liver”. Cases were included if the post-processing core length and number of portal tracts and central veins were present in the report. Referral cases and biopsies of mass lesions were excluded. Reports were reviewed and the following data extracted; number of cores, length of longest core, overall core length, number of portal tracts, number of central veins, Ishak stage. Any comments regarding adequacy were also recorded. For inadequate biopsies, the report archive was searched to determine if a repeat had been performed, and at what time after the original biopsy.
Results: 2796 core biopsies were reported in the study period, of which 1342 (48%) met the inclusion criteria. Applying the Royal College of Pathologists' guideline 266 (19.8%) would be considered adequate, 757 (56.4%) suboptimal and 319 (23.8%) inadequate, but in only 40 (15%) of the biopsies called inadequate by this standard was a comment to that effect included in the report. Only 2 (0.6%) of the inadequate biopsies were repeated within three months.
Conclusions: Diagnosis of medical liver diseases on core biopsy is usually supported by biochemical, microbiological and serological testing. Staging of diseases by core biopsy is subject to intraobserver variability, and there are increasing advances in non-invasive tests to detect fibrosis. Our review shows greater than 80% of our core biopsies would be considered inadequate or suboptimal for diagnosis and staging of medical liver diseases based on the Royal College of Pathologists' guidelines, but only a minority of these patients required a repeat biopsy. Therefore, with good clinicopathological correlation, auxiliary tests and improvements in technology perhaps, ultimately, core biopsy size does not matter at all.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 144, Tuesday Afternoon