Quantitative morphometry of compensated liver cirrhosis can aid to predict the outcomes of surgical treatment

Abstract

Objective — to define quantitative morphometric characteristics of hepatic parenchyma lesions at compensated liver cirrhosis (CLC), which will allow more accurately to assess its functional reserves and predict the outcomes of surgical treatment. Materials and methods. Intraoperative marginal liver biopsy was performed for 74 patients with CLC, who underwent surgical treatment. Morphological examinations with quantitative morphometry of intraoperative liver biopsies were done with the use of cytological analyzer with software «Integral‑2MT» produced by the association «Kvant» (Kyiv). The connective tissue area (CTA), unchanged hepatocytes area (UHA), stromal‑parenchymatous ratio (SPR), the volume of hepatocytes in the state of necrosis and/or necrobiosis (VHSNN), the volume of hepatocytes in the state of division (VHSD) were determined. The statistical analysis was performed by use of Statistica 12 software package. Results. Three types of morphological pattern of CLC were isolated. Type I (type A) portal cirrhosis with weakly pronounced signs of parenchymatous and stromal reaction (mono‑multilobular type, portal cirrhosis). The CTA was 66.73±1.71 mm2, SPR was 0.285±0.019, UHA was 234.13±11.5 mm2, VHSNN was 11.21±0.74%, VHSD was 10.23±0.57%. Type II cirrhosis (type B) — cirrhosis of mono‑multilobular type with moderately expressed signs of parenchymatous and stromal reaction. The CTA was 126.69±12.5 mm2, SPR was 0.617±0.031, UHA was 205.34±13.8 mm2, VHSNN was 17.32±0.63%, VHSD was 15.43±0.48%. Type III cirrhosis (type C) — cirrhosis with pronounced signs of parenchymatous and stromal reaction, more often of multilobular type. The CTA was 240.16±13.4 mm2, SPR was 1.344±0.089, UHA was 178.69±18.7 mm2, VHSNN was 23.97±0.75%, VHSD was 11.07±0.58%. Analysis of immediate results of surgical treatment demonstrated, that no one patient with A‑type CLC died, while 9.5% of patients with B‑type and 25.0% of patients with C‑type CLC died in the early postoperative period. Conclusions. Quantitative morphometry demonstrated that pathological changes in the liver at CLC are heterogeneous and can be categorized in to 3 types (A, B, C). Three types of morphological pattern at CLC, which were isolated, are characterized by significant differences in CTA, UHA, SPR, VHSNN, VHSD parameters. At transition of A‑type cirrhosis into C‑type, volume of hepatic parenchyma becomes to be decreased, while volume of connective tissue becomes to be increased. This is accompanied by decrease in UHA, increase in CTA, SPR and VHSNN. Surgical intervention in patients with type C morphological pattern of cirrhosis is associated with a high risk (25%) of poor outcome, which indicates the need to limitations for indications to elective surgical operations in this category of patients. Thus, quantitative morphometry of liver biopsies in CLC patients can aid to predict the outcomes of surgical treatment.