03:36 PM Abstract No. 310 Ultrasound elastography–guided liver biopsy: a value added technique to improve histopathological yield of liver fibrosis

Abstract

Liver fibrosis (LF) is essential in the evaluation of the severity of chronic liver disease as well as in its therapy. Liver biopsy, which can only assess a very limited part of the whole liver while fibrosis is a heterogeneously distributed lesion, is limited by sampling variability and therefore inaccurate histopathological yield. The objective of the study was to describe and evaluate a novel technique to enhance the histopathological yield by using ultrasound elastography simultaneously during liver biopsy. A total of 31 patients with chronic liver disease underwent ultrasound elastography–guided liver biopsy using an ultrasound unit (Siemens Acuson S3000) to determine quantitatively the liver stiffness (LS) and tissue elasticity with the Virtual Touch Tissue Quantification (VTTQ) and Imaging Quantification (VTIQ). The highest weighted LS liver tissue was then biopsied via intercostal and subcostal approaches for the right hepatic lobe and via an epigastric approach for the left hepatic lobe. The combined lengths of specimen fragments and the total number of complete portal tracts were measured by pathology. LS measurements were statistically correlated with different histopathological stages of fibrosis as well as the activity of necroinflammatory scoring systems composed of progressive stages: F0 (normal), F1 (portal fibrosis without septa), F2 (portal fibrosis few fibrotic septa), F3 (portal fibrosis with numerous septa) and F4 (cirrhosis), with p-value of 0.05 as considered significant. Valid LS and shearwave velocities measurements were obtained from all 31 patients except two patients (measurements had failed due to congestive heart failure and ascites). A gradual increase in mean LS measurements and shearwave velocities was noted from fibrosis of stages F1 to F4 with significant correlation between ultrasound elastography measurements and histopathological fibrosis stage (r = 0.95, p < 0.001) when compared to liver biopsy done without elastography. Ultrasound elastography–guided liver biopsy can improve histopathological yield in detecting liver fibrosis in patients with chronic liver disease.