Prospective evaluation of accuracy of liver biopsy findings in the identification of chemotherapy-associated liver injuries

Luca Viganò, Nicoletta Ravarino, Alessandro Ferrero, Manuela Motta, Bruno Torchio, Lorenzo Capussotti

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 languageEnglish
Pages (from-to)1085-1091
Number of pages7
JournalArchives of Surgery
Volume147
Issue number12
DOIs
Publication statusPublished - Dec 2012

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Biopsy
Drug Therapy
Liver
Wounds and Injuries
oxaliplatin
Fatty Liver
Dilatation
irinotecan
Odds Ratio
Inflammation
Tertiary Healthcare
Tertiary Care Centers
Obesity
Outcome Assessment (Health Care)
Prospective Studies
Neoplasm Metastasis
Sensitivity and Specificity
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

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 journalArticle

Viganò, Luca ; Ravarino, Nicoletta ; Ferrero, Alessandro ; Motta, Manuela ; Torchio, Bruno ; Capussotti, Lorenzo. / Prospective evaluation of accuracy of liver biopsy findings in the identification of chemotherapy-associated liver injuries. In: Archives of Surgery. 2012 ; Vol. 147, No. 12. pp. 1085-1091.
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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.",
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AU - Viganò, Luca

AU - Ravarino, Nicoletta

AU - Ferrero, Alessandro

AU - Motta, Manuela

AU - Torchio, Bruno

AU - Capussotti, Lorenzo

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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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