Introduction Non-invasive techniques for assessing hepatic fibrosis represent an alternative to core biopsies for staging fibrosis in chronic inflammatory conditions of the liver. We performed an audit to assess any change in the indications for liver biopsies following the introduction of transient elastography (FibroScan) into routine practice at Southampton General Hospital in 2010.
Method The reports of all core biopsies of liver received by the Cellular Pathology Department at Southampton General Hospital from 01/07/2008 to 30/06/2016 were retrieved. We identified medical liver biopsies by excluding specimens taken for assessment of neoplasia or mass lesions. We also excluded specimens referred from other hospitals. Clinical details from the pathology report, supplemented by other computerised patient records if necessary, were used to assign each case into one of the following categories depending on the principal indication for the biopsy: initial diagnosis; staging/grading of a known fibrotic liver disease; methotrexate treatment; assessment of known haemochromatosis; post-transplant; and protocol biopsy during a transjugular intrahepatic portosystemic stent shunt (TIPSS) procedure.
Results The annual numbers for each category and the total numbers are shown in the table. Over the seven years of the study, the annual total of medical liver biopsies fell by 66% from 268 to 92 (176 fewer biopsies). This was largely due to the reduction in the number of staging/grading biopsies from 131 to 10 annually (121 fewer biopsies), although there were also decreases in biopsies for initial diagnosis, assessment of haemochromatosis and assessment of methotrexate effect.
Conclusion The numbers of medical liver biopsies at Southampton General Hospital fell by 66% from 2008 to 2016. The largest fall was seen in staging/grading biopsies, consistent with the introduction of FibroScan. The results of this audit will be used in re-assessing service needs and job planning requirements.
Disclosure of Interest None Declared
- Liver biopsy