Skip to main content
SpringerLink
Log in

Die Leberbiopsie im Schnittpunkt von klinischer und pathologischer Diagnostik

Liver biopsy at the intersection of clinical and pathological diagnosis

Der Pathologe Aims and scope Submit manuscript

Cite this article

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.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Alvarez F, Berg PA, Bianchi FB et al. (1999) International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 31: 929–938

    Article  PubMed  CAS  Google Scholar 

  2. Bacon BR, Olynyk JK, Brunt EM et al. (1999) HFE genotype in patients with hemochromatosis and other liver diseases. Ann Intern Med 130: 953–962

    PubMed  CAS  Google Scholar 

  3. Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C in chronic hepatitis C. Hepatology 38: 1449–1457

    PubMed  Google Scholar 

  4. Burak KW, Angulo P, Lindor KD (2003) Is there a role of liver biopsy in primary sklerosing cholangitis? Am J Gastroenterol 98: 1155–1158

    Article  PubMed  Google Scholar 

  5. Bravo AA, Sheth SG, Chopra S (2001) Liver Biopsy. N Engl J Med 344: 495–500

    Article  PubMed  CAS  Google Scholar 

  6. Brunt EM (2001) Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 21: 3–16

    Article  PubMed  CAS  Google Scholar 

  7. Brunt EM, Tetri N, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 35: 1202–1219

    Google Scholar 

  8. Cadranel JF, Rufat P, Degos F for the group of epidemiology of the French Association for the study of the liver (2000) Hepatology 32: 477–481

  9. Chen CJ, Yang HI, Su J et al. REVEAL-HBV Study Group (2006) Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 295: 65–73

    Article  PubMed  CAS  Google Scholar 

  10. Colloredo G, Guido G, Sonzogi A, Leandro G (2003) Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 39: 239–244

    Article  PubMed  Google Scholar 

  11. Cornberg M, Protzer U, Dollinger MM et al. (2007) Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virus-(HBV)-Infektion. Z Gastroenterol 45: 525–574

    Article  PubMed  CAS  Google Scholar 

  12. Crawford AR, Lin XZ, Crawford JM (1998) The normal adult human liver biopsy: a quantitative reference standard. Hepatology 28: 323–331

    Article  PubMed  CAS  Google Scholar 

  13. Daniel S, Ben-Menachem T, Vasudevan G et al. (1999) Prospective evaluation of unexplained chronic liver transaminases abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 94: 3010–3014

    Article  PubMed  CAS  Google Scholar 

  14. Di Marco V, Lo Iacono O, Camma C et al. (1999) The longterm course of chronic hepatitis B. Hepatology 30: 257–264

    Article  Google Scholar 

  15. Fischer HP, Willsch E, Bierhoff E, Pfeifer U (1996) Histopathological findings in chronic hepatitis C. J Hepatol 24: 35–42

    PubMed  CAS  Google Scholar 

  16. Guido M, Rugge M (2004) Liver biopsy sampling in chronic viral hepatitis. Semin Liver Dis 24: 89–97

    PubMed  Google Scholar 

  17. 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

    PubMed  CAS  Google Scholar 

  18. Hultcrantz R, Gabrielson N (1993) Patients with persistent elevations of aminotransferases: investigations with ultrasonography, radionuclide imaging, and liver biopsy. J Intern Med 233: 7–12

    Article  PubMed  CAS  Google Scholar 

  19. Iloeje UH, Yang HI, Su J et al. (2006) Risk evaluation of viral load elevation and associated liver disease/cancer-in HBV (the REVEAL-HBV) study group. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology 130: 678–686

    Article  PubMed  Google Scholar 

  20. Jamal MM, Soni A, Quinn PG et al. (1999) Clinical features of hepatitis C–infected patients with persistently normal alanine transaminase activity in the Southwestern United States. Hepatology 30: 1307–1311

    Article  PubMed  CAS  Google Scholar 

  21. Janes CH, Lindor KD (1993) Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 118: 96–98

    PubMed  CAS  Google Scholar 

  22. Kalambokis G, Manousou P, Vibhakorn S et al. (2007) Tranjugular liver biopsy – Indications, adequacy, quality of specimens, and complications. A systematic review. J Hepatol 47: 284–294

    Article  PubMed  Google Scholar 

  23. Kim WR, Therneau T, Wiesner RH et al. (2000) A revised natural history model for primary sclerosing cholangitis. Mayo Clin Proc 75: 688–694

    PubMed  CAS  Google Scholar 

  24. Kyrlagkitsis I, Portmann B, Smith H et al. (2003) Liver histology and progression of fibrosis in individuals with chronic hepatitis C and persistently normal ALT. Am J Gastroenterol 98: 1588–1593

    Article  PubMed  Google Scholar 

  25. Labayle D, Chaput JC, Albuisson F et al. (1979) [Comparison of the histological lesions in tissue specimens taken from the right and left lobe of the liver in alcoholic liver disease]. Gastroenterol Clin Biol 3: 235–240

    PubMed  CAS  Google Scholar 

  26. Maharaj B, Maharaj RJ, Leavy WP (1986) Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet 1: 523–525

    Article  PubMed  CAS  Google Scholar 

  27. Martinot-Peignoux M, Boyer N, Cazals-Hatem D et al. (2001). Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA. Hepatology 34: 1000–1005

    Article  PubMed  CAS  Google Scholar 

  28. Mathurin P, Moussalli J, Cadranel JF et al. (1998) Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity. Hepatology 27: 868–872

    Article  PubMed  CAS  Google Scholar 

  29. Matteoni CA, Younossi ZM, Gramlich T et al. (1999) Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116: 1413–1419

    Article  PubMed  CAS  Google Scholar 

  30. Menghini G (1958) One-second needle biopsy of the liver. Gastroenterology 35: 190–199

    PubMed  CAS  Google Scholar 

  31. Monreno A, Carreno V, Cano A, Gonzalez C (1997) Idiopathic biliary ductopenia in adults without symptoms of liver disease. N Engl J Med 336: 835–838

    Article  Google Scholar 

  32. Pietrangelo A (2005) Non-HFE hemochromatosis. Semin Liver Dis 25: 450–460

    Article  PubMed  CAS  Google Scholar 

  33. Poulsen H, Christoffersen P (1970) Histological changes in liver biospies from patients with surgical bile duct disorders. Acta Pathol Microbiol Scand Section A 78: 571

    CAS  Google Scholar 

  34. Poynard T, Marcellin P, Lee SS et al. (1998) Randomized trial of interferon alpha-2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus: International hepatitis interventional therapy group. (IHT) Lancet 352: 1426–1432

    Google Scholar 

  35. Poynard T, Ratziu V, Bedossa P (2000) Appropriateness of liver biopsy. Can J Gastroenterol 14: 543–548

    PubMed  CAS  Google Scholar 

  36. Regev A, Mariana B, Jeffers LJ et al. (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97: 2614–2618

    Article  PubMed  Google Scholar 

  37. Saadeh S, Cammell G, Carey WD et al. (2001) The role of liver biopsy in chronic hepatitis C. Hepatology 33: 196–200

    Article  PubMed  CAS  Google Scholar 

  38. Saadeh S, Younossi ZM, Remer EM et al. (2002) The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123: 745–750

    Article  PubMed  Google Scholar 

  39. Schirmacher P, Fleig WE, Tannapfel A et al. (2004) Bioptische Diagnostik der chronischen Hepatitis. Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Pathologie (DPG), der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DVGS) und des Kompetenznetzes Hepatitis (HepNet). Pathologe 25: 337–348

    Article  PubMed  CAS  Google Scholar 

  40. Skelly MM, James PD, Ryder SD (2001) Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 35: 195–199

    Article  PubMed  CAS  Google Scholar 

  41. Spycher C, Zimmermann A, Reichen J (2001) The diagnostic value of liver biopsy. BMC Gastroenterol 1: 12

    Article  PubMed  CAS  Google Scholar 

  42. Stanley AJ, Haydon GH, Piris J et al. (1996) Assessment of liver histology in patients with hepatitis C and normal transaminase levels. Eur J Gastroenterol Hepatol 8: 869–872

    Article  PubMed  CAS  Google Scholar 

  43. Talley NJ, Roth JA, Hench WV (1988) Diagnostic value of liver biopsy in alcoholic liver disease. J Clin Gastroenterol 10: 647–650

    Article  PubMed  CAS  Google Scholar 

  44. Tavill AS (1999) Diagnosis and management of hemochromatosis. Hepatology 33: 1321–1328

    Article  Google Scholar 

  45. Teli MR, James OF, Burt AD et al. (1995) The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 22: 1714–1719

    Article  PubMed  CAS  Google Scholar 

  46. Terjung B, Lemnitzer I, Dumoulin FL et al. (2003) Bleeding complications after percutaneous liver biopsy. An analysis of risk factors. Digestion 67: 138–145

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  48. Theodossi A, Spiegelhalter D, Portmann B et al. (1983) The value of clinical, biochemical, ultrasound and liver biopsy data in assessing patients with liver disease. Liver 3: 315–326

    PubMed  CAS  Google Scholar 

  49. Von Frerichs FT (1884) Über den Diabetes. Hirschwald, Berlin

  50. Westin J, Nordlinder H, Lagging M et al. (2002) Steatosis accelerates fibrosis development over time in hepatitis C virus genotype 3 infected patients. J Hepatol 37: 837–842

    Article  PubMed  Google Scholar 

  51. Zeuzem S, Feinman SV, Rasenack J et al. (2000) Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med 343: 1666–1672

    Article  PubMed  CAS  Google Scholar 

Download references

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.

Interessenkonflikt

Die korrespondierenden Autoren versichern, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  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

Authors
  1. U. Spengler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-P. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

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

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-007-0960-4

Schlüsselwörter

Keywords

search

Navigation