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Influence of Liver Biopsy Heterogeneity and Diagnosis of Nonalcoholic Steatohepatitis in Subjects Undergoing Gastric Bypass

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Background

Nonalcoholic fatty liver disease (NAFLD) is a chronic condition that can progress to cirrhosis and hepatocellular cancer. The most progressive form of NAFLD is nonalcoholic steatohepatitis (NASH). Currently, the only method to diagnose NASH is with a liver biopsy; however. sampling error may limit diagnostic accuracy. We investigated the discordance of paired liver biopsies in individuals undergoing gastric bypass.

Methods

Two liver biopsies, composite size of ≥25 mm and ≥8 portal tracts (PTs), were obtained from the left lobe in 31 subjects. Group 1 included specimens at least 15 mm in length with ≥4 PTs compared to a second biopsy of at least 10 mm and ≥4 PTs (Group 2).

Results

The mean specimen size (number of PTs) for group 1 was 20.4 ± 4.2 mm (11.7 ± 5.5 PTs) and group 2 was 16.1 ± 5.3 mm (8.2 ± 4.1 PTs). Prevalence of NASH was 26% in Group 1 and 32% in Group 2. Sampling discordance was greatest for portal fibrosis (26%), followed by zone 3 fibrosis (13%) and ballooning degeneration (3%). The negative predictive values from Group 1 liver biopsies for NASH and portal fibrosis were only 83% and 67%, respectively.

Conclusions

The results demonstrate that significant sampling variability exists in class 2 and 3 obese individuals undergoing screening liver biopsies for NAFLD. The degree and histopathological discordance is dependent upon zonal location and types of injury. Nevertheless, a 25-mm biopsy specimen without zone 3 cellular ballooning or fibrosis appears adequate to exclude the diagnosis of NASH.

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Abbreviations

NIH:

National Institutes of Health

NAFLD:

nonalcoholic fatty liver disease

FL:

fatty liver

NASH:

nonalcoholic steatohepatitis

IPF:

isolated portal fibrosis

ATP III:

Third Report of the National Cholesterol Education Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults Treatment Panel

AST:

aspartate aminotransferase

ALT:

alanine aminotransferase

TG:

triglycerides

HDL:

high density lipoprotein

OGTT:

oral glucose tolerance test

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama, Birmingham, AL, USA

    Janani Arun MD & Gary A. Abrams MD

  2. Department of Pathology, University of Alabama, Birmingham, AL, USA

    Niraj Jhala MD & Audrey J. Lazenby MD

  3. Division of GI Surgery, Department of Surgery, University of Alabama, Birmingham, AL, USA

    Ronald Clements MD

  4. University of Alabama at Birmingham, UAB Liver Center, 1530 3rd Ave. S., 286 MCLM, Birmingham, AL, 35294, USA

    Gary A. Abrams MD

Authors
  1. Janani Arun MD
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  2. Niraj Jhala MD
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  3. Audrey J. Lazenby MD
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  4. Ronald Clements MD
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  5. Gary A. Abrams MD
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Corresponding author

Correspondence to Gary A. Abrams MD.

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Arun, J., Jhala, N., Lazenby, A.J. et al. Influence of Liver Biopsy Heterogeneity and Diagnosis of Nonalcoholic Steatohepatitis in Subjects Undergoing Gastric Bypass. OBES SURG 17, 155–161 (2007). https://doi.org/10.1007/s11695-007-9041-2

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  • DOI: https://doi.org/10.1007/s11695-007-9041-2

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