Introduction Histopathologists working in a district general hospital usually do not have a subspecialist interest in hepatology. Most district general hospitals have a gastroenterology service and local pathologists usually report liver biopsies. The Royal College of Pathologist (RCP) recommend that ‘as minimal acceptable practise’ a liver biopsy report should include the clinical diagnosis, biopsy size, overall architecture, degree of fibrosis, severity in chronic liver disease (staging/grading), a definitive diagnosis or discussion of the differential diagnosis. Appropriate negative findings (e.g. lack of iron overload or alpha-1-antitrypsin globules) should be documented in the report.
Methods A retrospective analysis of all liver biopsies between January 2010 to February 2012 at two district general hospitals (Barnet and Chasefarm NHS trust) in North London was performed. Data was collected from medical records and electronic results. Our aim was to assess whether liver biopsies provided the clinician with adequate information about diagnosis.
Results 107 liver biopsies were performed during this period under ultrasound guidance by a radiologist. Mean patient age was 62 years (Range 19 –90). The mean number of core biopsies per patient was 1.5 (range 1 – 6). 10.7% (10/107) of the report did not mention a clinical diagnosis. 30% (32/107) of the biopsy report did not have a definitive or a differential diagnosis about possible aetiology of underlying liver disease. However 98% (47/48) of patients with cancer had a diagnosis on histology. Only 53% (9/17) patients with chronic hepatitis had severity scoring (Ishak staging/grading).
Conclusion About one third of liver biopsies did not have diagnosis or discussion about a differential diagnosis. This number goes up to 47.5% (28/59) if we exclude malignancies. 9/28 specimens were sent to a tertiary centre and reported by a liver pathologist who gave a definite or differential diagnosis in all cases. The mortality associated with percutaneous liver biopsy ranges between 0.13 and 0.33%. from an audit from UK district general hospital. With the advent of fibroscan there is less need to perform liver biopsies except in diagnosing malignancies or in hepatitis of unknown/unclear aetiology. From our study we conclude that non-cancer liver biopsies should be reported by pathologists with subspecialist interest in hepatology or the procedure should be performed in a tertiary hospital to give the clinician an accurate diagnosis to aid treatment.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.