Abstract
Objective: To evaluate the accuracy of liver biopsy findings in preoperative assessment of chemotherapy-associated liver injuries (CALIs). Design : Prospective study. Setting: Tertiary care referral hospital. Patients: From July 1, 2007, to January 31, 2011, all patients with colorectal metastases receiving preoperative oxaliplatin- and/or irinotecan-based chemotherapy (≥4 cycles) were considered for the present study. Patients underwent parenchymal biopsy before liver resection. Blinded CALI evaluation was performed on biopsy and resection specimens. Intervention: Liver resection. Main Outcome Measures: Sensitivity, specificity, and accuracy of liver biopsy in CALI evaluation. Results: We included 100 patients. At specimen analysis, grade 2or 3 steatosis was diagnosed in 30 patients; grade 2 or 3 sinusoidal dilatation, in 28; grade 2 hepatocellular ballooning, in 3; grade 2 or 3 lobular inflammation, in 25; and steatohepatitis in 19. Obesity was associated with grade 3 steatosis (20.8% vs 5.3%; odds ratio [OR], 4.74 [P =.03]) and steatohepatitis (33.3% vs 14.5%; OR, 2.96 [P =.04]). Oxaliplatin administration was associated with higher sinusoidal dilatation grade (P =.049). Mortality (2 cases) was increased among patients with steatohepatitis (10.5% vs 0; OR, 13.67 [P =.04]). Biopsy findings correctly predicted steatosis (sensitivity, 88.9%; accuracy, 93.0%) but had low sensitivity and accuracy for sinusoidal dilatation (21.4% and 63.0%, respectively), hepatocellular ballooning (16.0% and 69.0%, respectively), lobular inflammation (20.0% and 78.0%, respectively), and steatohepatitis (21.1% and 79.0%, respectively). Biopsy accuracy did not improve regarding specific chemotherapy regimens or prolonged treatments. Conclusions: Liver biopsy cannot be considered a reliable tool in assessing CALIs except for steatosis. The procedure should not be recommended during preoperative workup.
| Original language | English |
|---|---|
| Pages (from-to) | 1085-1091 |
| Number of pages | 7 |
| Journal | Archives of Surgery |
| Volume | 147 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Dec 2012 |
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- Surgery
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Prospective evaluation of accuracy of liver biopsy findings in the identification of chemotherapy-associated liver injuries. / Viganò, Luca; Ravarino, Nicoletta; Ferrero, Alessandro; Motta, Manuela; Torchio, Bruno; Capussotti, Lorenzo.
In: Archives of Surgery, Vol. 147, No. 12, 12.2012, p. 1085-1091.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prospective evaluation of accuracy of liver biopsy findings in the identification of chemotherapy-associated liver injuries
AU - Viganò, Luca
AU - Ravarino, Nicoletta
AU - Ferrero, Alessandro
AU - Motta, Manuela
AU - Torchio, Bruno
AU - Capussotti, Lorenzo
PY - 2012/12
Y1 - 2012/12
N2 - Objective: To evaluate the accuracy of liver biopsy findings in preoperative assessment of chemotherapy-associated liver injuries (CALIs). Design : Prospective study. Setting: Tertiary care referral hospital. Patients: From July 1, 2007, to January 31, 2011, all patients with colorectal metastases receiving preoperative oxaliplatin- and/or irinotecan-based chemotherapy (≥4 cycles) were considered for the present study. Patients underwent parenchymal biopsy before liver resection. Blinded CALI evaluation was performed on biopsy and resection specimens. Intervention: Liver resection. Main Outcome Measures: Sensitivity, specificity, and accuracy of liver biopsy in CALI evaluation. Results: We included 100 patients. At specimen analysis, grade 2or 3 steatosis was diagnosed in 30 patients; grade 2 or 3 sinusoidal dilatation, in 28; grade 2 hepatocellular ballooning, in 3; grade 2 or 3 lobular inflammation, in 25; and steatohepatitis in 19. Obesity was associated with grade 3 steatosis (20.8% vs 5.3%; odds ratio [OR], 4.74 [P =.03]) and steatohepatitis (33.3% vs 14.5%; OR, 2.96 [P =.04]). Oxaliplatin administration was associated with higher sinusoidal dilatation grade (P =.049). Mortality (2 cases) was increased among patients with steatohepatitis (10.5% vs 0; OR, 13.67 [P =.04]). Biopsy findings correctly predicted steatosis (sensitivity, 88.9%; accuracy, 93.0%) but had low sensitivity and accuracy for sinusoidal dilatation (21.4% and 63.0%, respectively), hepatocellular ballooning (16.0% and 69.0%, respectively), lobular inflammation (20.0% and 78.0%, respectively), and steatohepatitis (21.1% and 79.0%, respectively). Biopsy accuracy did not improve regarding specific chemotherapy regimens or prolonged treatments. Conclusions: Liver biopsy cannot be considered a reliable tool in assessing CALIs except for steatosis. The procedure should not be recommended during preoperative workup.
AB - Objective: To evaluate the accuracy of liver biopsy findings in preoperative assessment of chemotherapy-associated liver injuries (CALIs). Design : Prospective study. Setting: Tertiary care referral hospital. Patients: From July 1, 2007, to January 31, 2011, all patients with colorectal metastases receiving preoperative oxaliplatin- and/or irinotecan-based chemotherapy (≥4 cycles) were considered for the present study. Patients underwent parenchymal biopsy before liver resection. Blinded CALI evaluation was performed on biopsy and resection specimens. Intervention: Liver resection. Main Outcome Measures: Sensitivity, specificity, and accuracy of liver biopsy in CALI evaluation. Results: We included 100 patients. At specimen analysis, grade 2or 3 steatosis was diagnosed in 30 patients; grade 2 or 3 sinusoidal dilatation, in 28; grade 2 hepatocellular ballooning, in 3; grade 2 or 3 lobular inflammation, in 25; and steatohepatitis in 19. Obesity was associated with grade 3 steatosis (20.8% vs 5.3%; odds ratio [OR], 4.74 [P =.03]) and steatohepatitis (33.3% vs 14.5%; OR, 2.96 [P =.04]). Oxaliplatin administration was associated with higher sinusoidal dilatation grade (P =.049). Mortality (2 cases) was increased among patients with steatohepatitis (10.5% vs 0; OR, 13.67 [P =.04]). Biopsy findings correctly predicted steatosis (sensitivity, 88.9%; accuracy, 93.0%) but had low sensitivity and accuracy for sinusoidal dilatation (21.4% and 63.0%, respectively), hepatocellular ballooning (16.0% and 69.0%, respectively), lobular inflammation (20.0% and 78.0%, respectively), and steatohepatitis (21.1% and 79.0%, respectively). Biopsy accuracy did not improve regarding specific chemotherapy regimens or prolonged treatments. Conclusions: Liver biopsy cannot be considered a reliable tool in assessing CALIs except for steatosis. The procedure should not be recommended during preoperative workup.
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U2 - 10.1001/archsurg.2012.1867
DO - 10.1001/archsurg.2012.1867
M3 - Article
VL - 147
SP - 1085
EP - 1091
JO - Archives of Surgery
JF - Archives of Surgery
SN - 0004-0010
IS - 12
ER -