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Abstract
Background: Controversy exists over whether or not single-needle liver biopsies are sufficient to compare histological parameters in patients with non-alcoholic fatty liver disease.
Aims: To identify sampling variability, we biopsied four liver specimens per patient, based on biopsy size (needle vs wedge) and location (left vs right lobe), immediately prior to bariatric Roux-en-Y gastric bypass surgery.
Methods: Ten prospectively enrolled, morbidly obese patients underwent 40 laparoscopy-guided biopsies; two needle and two wedge from each of 16 left and 16 right liver lobes. The Kappa coefficient for concordance compared histological parameters from left and right lobe needle- and wedge biopsies. Wedge biopsies were considered our ‘Gold Standard’.
Results: Each patient had two wedge- and two needle liver biopsies. Kappa concordance between all needle and wedge biopsies from right and left lobes showed variability. Wedge- and needle liver biopsies from contralateral lobes had higher concordance with each other, compared to ipsilateral needle/wedge biopsy pairs. Contralateral wedge pairs had higher concordance than contralateral needle/needle pairs. There were no biopsy complications.
Conclusions: Wedge biopsy pairs had the best Kappa concordance but contralateral needle/needle biopsy pairs had good Kappa concordance. There were no complications from the 40 needle- and wedge liver biopsies, confirming the safety of laporoscopic multi-biopsy in both liver lobes.
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Details
1 Division of Gastroenterology, Department of Medicine, State University of New York (SUNY), Upstate Medical University, Syracuse, NY, USA, 2 Associates in Gastroenterology, Rockville, MD, USA, 3 Department of Surgery, SUNY, Upstate Medical University, Syracuse, NY, USA, 4 Department of Pathology, SUNY, Upstate Medical University, Syracuse, NY, USA and 5 Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA