Appleby, V

Gavin, Helen

Georgiades, I

Kon, M

Moreea, S

English

University of Huddersfield Repository

University of Huddersfield RepositoryAppleby, V, Gavin, Helen, Kon , M, Georgiades, I and Moreea, SThe adequacy of liver biopsies can be predicted from the length of fresh tissue obtained at the time of biopsy – review of Original CitationAppleby, V, Gavin, Helen, Kon , M, Georgiades, I and Moreea, S (2010) The adequacy of liver biopsies can be predicted from the length of fresh tissue obtained at the time of biopsy – review of. In: European Association for the study of liver diseases , April 14-18, 2010, Vienna, Austria. (Unpublished)This version is available at http://eprints.hud.ac.uk/6781/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/The adequacy of liver biopsies can be predicted from the length of fresh tissue obtained atthe time of biopsy – review of a large case series.Appleby V, Gavin H, Kon M, Georgiades I and Moreea SDigestive Disease Centre, Bradford Hospitals Foundation Trust, Duckworth Lane, Bradford BD96RJ, UK.Background and aim:  It is now accepted that an adequate liver biopsy should have at least 10portal tracts1.  We asked the question: what length of fresh tissue would guarantee enoughmicroscopic tissue for an adequate liver biopsy after allowing for shrinkage during tissue fixation?Methods: Data from our reporting systems was analysed for the following: length of macroscopictissue before tissue processing, microscopic length on the pathology slides, number of portal tractsin each biopsy and diagnosis. We also conducted a prospective pilot study to correlate length offresh tissue at the time of biopsy with the length of macroscopic tissue when the specimen arrivesin the lab in formalin. Results: Between 2004-2008, there were 412 ultrasound-guided liver biopsies in 195 females (F)and 217 males (M). Portal tracts could not be counted in the following: 98 cases of malignancy(F=55 M=43 mean 64 yrs)  42 cases of cirrhosis (F=23 M=19 mean 55 yrs) and 14 insufficientbiopsies (F= 7 M=7 mean 55 yrs).  Of the remaining 258 biopsies, statistical analysis wasperformed on the 192 (75%) samples where all the variables were available. The diagnoses were:119 viral hepatitis (F=45 M=74  mean 37yrs) 35 fatty liver disease (F= 14 ,M= 21 mean49yrs) 10 haemochromatosis (F=2  M=8  mean 59yrs) 7 autoimmune hepatitis (F=6 M=1 mean50 yrs)  6 normal liver ( F=3  M=3 , mean 43 y) 4 cholestatic liver disease (F=2 M=2 mean54yrs) 4 drug induced liver injury (F=3 M=1 mean  39yrs)  7 others (F=5  M=2  mean  51yrs).After removing outliers in the data, and using linear regression analysis, the length of themacroscopic tissue accounted for 95.1% of the variance in the microscopic tissue and 85.2% ofthe variance in the number of portal tracts.Chi-square analysis showed that age ((2 = 2.511, p>0.05  ) and sex ((2 = 0.535 p>0.05 ) were non-significant parameters in the acquisition of sufficient portal tracts. We calculated that 29 mm ofmacroscopic tissue equating to 26 mm of microscopic tissue (p<0.01) would guarantee anadequate liver biopsy with at least 10 portal tracts in any diagnosis excluding cirrhosis andmalignancy. Our pilot study of 10 consecutive biopsies showed no tissue shrinkage duringtransport in formalin to the lab. In this current larger sample, the tissue did show shrinkage (froma mean length of 23.82 mm to 21.01 mm), but this change is consistent (r=0.829 p<0.01).Conclusion: Using an 18 Fr needle we suggest that operators ensure that they obtain at least 18mm of fresh liver tissue from  to ensure that patients have an accurate diagnosis and avoid a repeatbiopsy. To our knowledge this is the first study showing these findings.ReferencesTaylor DM et al. Gastroenterology 2008; 134 (S1): A-834

The adequacy of liver biopsies can be predicted from the length of fresh tissue obtained at the time of biopsy – review of

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