Skip to main content
SpringerLink
Log in

Feasibility of histological grading and staging of chronic viral hepatitis using specimens obtained by thin-needle biopsy

  • Original Article
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

We performed a retrospective study to investigate the feasibility of grading and staging of chronic viral hepatitis on specimens obtained by means of thin-needle biopsy (TNB; 20G) using the modified Ishak-system (J Hepatol 1995; 22:696–699). Specimens obtained using large-needle biopsy (LNB; 17G) served as a control. A total of 100 biopsy specimens from 88 patients were included in the study. Of the patients, 30 suffered from chronic hepatitis B, 54 from chronic hepatitis C, and 4 from both; 59 specimens were obtained by TNB and 41 by LNB. All four categories of the Ishak-system, i.e., interface hepatitis, confluent necrosis, lobular inflammation and portal inflammation, could be applied to TNB specimens and provided similar total scores to those observed in LNB specimens. Specimens obtained by TNB facilitated the diagnosis of liver cirrhosis. However, they bore the risk of underestimating the presence of cirrhosis in favor of advanced bridging fibrosis, whereas no differences were found in the overall recognition of liver fibrosis. Intra- and interobserver variabilities were not affected by the needle size. For the interobserver agreement, the kappa values for the category of inflammation ranged from 0.003 to 0.419 (TNB) and 0.096 to 0.470 (LNB) and for staging we noted kappa values of 0.351 (TNB) and 0.456 (LNB). Reproducibility increased when a tolerance of ±1 was accepted for grading (total score) and staging; in this case, observer variability was less than 20%. This study showed that grading and staging of chronic viral hepatitis is feasible in TNB specimens and that intra- and interobserver variability poses a greater problem than needle size.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bedossa P (1994) Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 20:15–20

    PubMed  Google Scholar 

  2. Bortz J, Lienert GA, Boehnke K (ed) (1990) Verteilungsfreie Methoden in der Biostatistik. Springer Berlin Heidelberg New York.

  3. Boyer JL, Klatskin G (1970) Pattern of necrosis in acute viral hepatitis. Prognostic value of bridging (subacute hepatic necrosis). N Engl J Med 283:1063–1071

    CAS  PubMed  Google Scholar 

  4. Chevallier M, Guerret S, Chossegros P, Gerard F, Grimaud JA (1994) A histological semiquantitative scoring system for evaluation of hepatic fibrosis in needle liver biopsy specimens: comparison with morphometric studies. Hepatology 20:349–355

    CAS  PubMed  Google Scholar 

  5. Cooksley WG, Bradbear RA, Robinson W, Harrison M, Halliday JW, Powell LW, Ng HS, Seah CS, Okuda K, Scheuer PJ (1986) The prognosis of chronic active hepatitis without cirrhosis in relation to bridging necrosis. Hepatology 6:345–348

    CAS  PubMed  Google Scholar 

  6. Di Bisceglie AM (1999) Chronic hepatitis C viral infection in patients with normal serum alanine aminotransferases. Am J Med 107:53S–55S

    PubMed  Google Scholar 

  7. Edoute Y, Tibon-Fisher O, Ben Haim S, Malberger E (1992) Ultrasonically guided fine-needle aspiration of liver lesions. Am J Gastroenterol 87:1138–1141

    CAS  PubMed  Google Scholar 

  8. Fanning L, Kenny E, Sheehan M, Cannon B, Whelton M, O'Connell J, Collins JK, Shanahan F (1999) Viral load and clinicopathological features of chronic hepatitis C (1b) in a homogeneous patient population. Hepatology 29:904–907

    CAS  PubMed  Google Scholar 

  9. Gebel M, Horstkotte H, Koster C, Brunkhorst R, Brandt M, Atay Z (1986) Ultrasound-guided fine needle puncture of the abdominal organs: indications, results, risks. Ultraschall Med 7:198–202

    CAS  PubMed  Google Scholar 

  10. Glaser J, Pausch J (1995) The risk of liver biopsy. Z Gastroenterol 33:673–676

    CAS  PubMed  Google Scholar 

  11. Haber MM, West AB, Haber AD, Reuben A (1995) Relationship of aminotransferases to liver histological status in chronic hepatitis C. Am J Gastroenterol 90:1250–1257

    CAS  PubMed  Google Scholar 

  12. Healey CJ, Chapman RW, Fleming KA (1995) Liver histology in hepatitis C infection: a comparison between patients with persistently normal or abnormal transaminases. Gut 37:274–278

    CAS  PubMed  Google Scholar 

  13. Holtkamp W, Theilmeier A, Droese M, Ebert R, Reis HE (1990) Ultrasonically guided fine-needle puncture. The limits of the method in the abdomen and retroperitoneal space. Dtsch Med Wochenschr 115:809–812

    CAS  PubMed  Google Scholar 

  14. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, Phillips MJ, Portman BG, Poulsen H, Scheuer PJ, Schmid M, Thaler H (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699

    Article  CAS  PubMed  Google Scholar 

  15. Kutcher R, Smith GS, Sen F, Gelman SF, Mitsudo S, Thung SN, Reinus JF (1998) Comparison of sonograms and liver histologic findings in patients with chronic hepatitis C virus infection. J Ultrasound Med 17:321–325

    CAS  PubMed  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    PubMed  Google Scholar 

  17. Lindor KD, Bru C, Jorgensen RA, Rakela J, Bordas JM, Gross JB, Rodes J, McGill DB, Reading CC, James EM, Charboneau JW, Ludwig J, Batts KP, Zinsmeister AR (1996) The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology 23:1079–1083

    CAS  PubMed  Google Scholar 

  18. MacSween RN (1980) Pathology of viral hepatitis and its sequelae. Clin Gastroenterol 9:23–45

    CAS  PubMed  Google Scholar 

  19. McCormick SE, Goodman ZD, Maydonovitch CL, Sjogren MH (1996) Evaluation of liver histology, ALT elevation, and HCV RNA titer in patients with chronic hepatitis C. Am J Gastroenterol 91:1516–1522

    CAS  PubMed  Google Scholar 

  20. Menghini G (1970) One-second biopsy of the liver--problems of its clinical application. N Engl J Med 283:582–585

    CAS  PubMed  Google Scholar 

  21. Pasha T, Gabriel S, Therneau T, Dickson ER, Lindor KD (1998) Cost-effectiveness of ultrasound-guided liver biopsy. Hepatology 27:1220–1226

    CAS  PubMed  Google Scholar 

  22. Reedy DW, Loo AT, Levine RA (1998) AST/ALT ≥1 is not diagnostic of cirrhosis in patients with chronic hepatitis C. Dig Dis Sci 43:2156–2159

    CAS  PubMed  Google Scholar 

  23. Röcken C, Meier H, Klauck S, Wolff S, Malfertheiner P, Roessner A (2001) Large needle biopsy versus thin needle biopsy in diagnostic pathology of liver diseases. Liver 21:391--397

    Article  PubMed  Google Scholar 

  24. Scheuer PJ (1997) Chronic hepatitis: what is activity and how should it be assessed? Histopathology 30:103–105

    CAS  PubMed  Google Scholar 

  25. Sheth SG, Flamm SL, Gordon FD, Chopra S (1998) AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 93:44–48

    Article  CAS  PubMed  Google Scholar 

  26. Weiss H, Weiss A, Scholl A (1988) Fatal complication of fine-needle biopsy of the liver. Dtsch Med Wochenschr 113:139–142

    CAS  PubMed  Google Scholar 

  27. Westin J, Lagging LM, Wejstal R, Norkrans G, Dhillon AP (1999) Interobserver study of liver histopathology using the Ishak score in patients with chronic hepatitis C virus infection. Liver 19:183–187

    CAS  PubMed  Google Scholar 

  28. Wrba F, Renner F (1998) Recommendations for clinicopathologic quality standards in gastroenterology and hepatology. Consensus report of the Austrian Society of Gastroenterology ahd Hepatology and the Austrian Society of Pathology. Z Gastroenterol 36:917–923

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Otto-von-Guericke-University, Leipziger Strasse 44, 39120 , Magdeburg, Germany

    Daniela Petz, Albert Roessner & Christoph Röcken

  2. Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Germany

    Sabine Klauck & Peter Malfertheiner

  3. Department of Biometrics, Otto-von-Guericke-University, Magdeburg, Germany

    Friedrich-Wilhelm Röhl

Authors
  1. Daniela Petz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabine Klauck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Friedrich-Wilhelm Röhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Malfertheiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Albert Roessner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Röcken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Röcken.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petz, D., Klauck, S., Röhl, FW. et al. Feasibility of histological grading and staging of chronic viral hepatitis using specimens obtained by thin-needle biopsy. Virchows Arch 442, 238–244 (2003). https://doi.org/10.1007/s00428-002-0749-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-002-0749-z

Keywords

Search

Navigation