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Die Leberbiopsie im Schnittpunkt von klinischer und pathologischer Diagnostik

Liver biopsy at the intersection of clinical and pathological diagnosis

  • Schwerpunkt: Leberpathologie
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Zusammenfassung

Die Leberbiopsie ist wichtiger Teil im Spektrum diagnostischer Verfahren der Hepatologie. Biochemische, immunologische, funktionelle und molekulare Befunde der Klinik erlauben es, in vielen Fällen die Ätiologie einer Lebererkrankung zu definieren. Die Biopsie hat hierzu prognose- und therapierelevante Informationen zum Stadium und zur Aktivität auf der Basis von Konsensuskriterien beizutragen. Die Analyse des histologischen Fibrosemusters erlaubt über den quantitativen Aspekt hinaus, wichtige Rückschlüsse auf die Ursache und den Progress einer Lebererkrankung. Hepatitis C, autoimmune Hepatitis, unklare überraschend schwere Verläufe der Hepatitis B, die Abgrenzung von einfacher Steatose gegenüber nichtalkoholischer Steatohepatitis, die Differenzialdiagnose unklarer cholestatischer Erkrankungen, unklare Hepatopathien, Transplantatpathologie und nicht zuletzt die Diagnose hepatischer Raumforderungen stehen im Fokus der leberbioptischen Diagnostik. Erhöhtes Blutungsrisiko ist durch eine transjuguläre Biopsie minimierbar. Raumforderungen sind durch bildgesteuerte Punktion gezielt zu erfassen. Regelmäßige klinisch-pathologische Konferenzen helfen bei der Klärung des leberdiagnostischen Einzellfalls und fördern wesentlich die diagnostische Kompetenz des hepatologisch tätigen Klinikers und Pathologen.

Abstract

Liver biopsy plays an important role in the diagnosis of liver diseases. Nowadays, biochemical, immunological, functional and molecular tests allow the etiology of many liver diseases to be clarified. The liver biopsy contributes essential information about the stage and grade of inflammatory liver diseases on the basis of consensus criteria. These data influence treatment and help to assess the prognosis. In addition, the different patterns of fibrosis allow conclusions about the cause and progress of the underlying liver disease. Hepatitis C, autoimmune hepatitis, unexplained severe course of hepatitis B, differentiation of simple steatosis from steatohepatitis, the differential diagnosis of cholestatic diseases, unclear hepatopathy, transplant pathology and last but not least, hepatic masses are the focal points of liver biopsy diagnoses. Increased risk of hemorrhage due to coagulation defects can be minimized by a transjugular biopsy. Liver masses can be effectively located and identified by radiologically or ultrasound-guided biopsy. Regular periodic conferences between clinicians and pathologists help to clarify individual problematic cases and will promote the diagnostic competence of both partners in hepatology.

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Danksagung

Für die Herstellung der Schnittpräparate und Färbungen danken wir Frau Susanne Steiner, für die Hilfe bei der Bildbearbeitung danken wir Herrn Gerrit Klemm und Frau Maike Streit.

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  1. Medizinische Klinik 1, Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    U. Spengler

  2. Institut für Pathologie, Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    H.-P. Fischer

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  1. U. Spengler
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  2. H.-P. Fischer
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Correspondence to U. Spengler or H.-P. Fischer.

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Spengler, U., Fischer, HP. Die Leberbiopsie im Schnittpunkt von klinischer und pathologischer Diagnostik. Pathologe 29, 6–14 (2008). https://doi.org/10.1007/s00292-007-0960-4

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