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Evaluation of the histological variability of core and wedge biopsies in nonalcoholic fatty liver disease in bariatric surgical patients

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Abstract

Background

Liver biopsy remains the gold standard for characterizing and evaluating treatment response in nonalcoholic fatty liver disease (NAFLD). Liver heterogeneity and sampling variability can affect the reliability of results. This study aimed to compare histological variability of intraoperative wedge and core liver biopsies from different lobes in bariatric patients, to better inform surgeons on biopsy method and guide interpretation of results.

Methods

We prospectively recruited bariatric surgical patients. Intraoperative core biopsies were taken from the left and right lobe, with a wedge biopsy taken from the left. All biopsies were graded by a specialist liver pathologist, blinded to clinical details and biopsy site. Concordance of histological findings between sites was evaluated.

Results

There were 91 participants (72.2% female), mean age 46.8 ± 12.0 years, body mass index 45.9 ± 9.4 kg/m2. There was no significant pattern for up- or down-grading disease dependent on biopsy technique. Moderate to strong agreement was seen in the presence of NAFLD and nonalcoholic steatohepatitis (NASH, κ = 0.609–0.865, p < 0.001) between biopsy sites. Individual components (steatosis, inflammation, ballooning) showed weaker agreement (κ = 0.386–0.656, p < 0.01). Fibrosis showed particularly poor agreement (κ = 0.223–0.496, p < 0.01). Detection of pathology improved with a combination of biopsy techniques, compared to a single biopsy method.

Conclusion

Overall diagnosis of NAFLD or NASH shows good agreement between biopsy sites, but individual components, particularly fibrosis stage, vary significantly. Clinicians should consider biopsies from varied sites, to better assess liver disease severity. These data have important implications in fibrosis assessment of NAFLD and are relevant in the interpretation of histological efficacy of investigational pharmacotherapies.

Trial registration: ACTRN12615000875505 (Australian Clinical Trials Register).

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

HREC:

Human Research Ethics Committee

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Nonalcoholic steatohepatitis

SD:

Standard deviation

ULN:

Upper limit of normal

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Funding

This work was supported by the National Health and Medical Research Council and the Royal Australasian College of Surgeons.

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Authors and Affiliations

  1. Department of Surgery, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Prahran, Melbourne, Australia

    Geraldine J. Ooi, Yazmin Johari, Wendy A. Brown & Paul R. Burton

  2. Department of General Surgery, The Alfred Hospital, Melbourne, Australia

    Geraldine J. Ooi, Yazmin Johari, Wendy A. Brown & Paul R. Burton

  3. University of Queensland, Brisbane, Australia

    Andrew Clouston

  4. Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Andrew Clouston

  5. Envoi Specialist Pathology, Brisbane, Australia

    Andrew Clouston

  6. Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia

    William W. Kemp & Stuart K. Roberts

Authors
  1. Geraldine J. Ooi
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  2. Andrew Clouston
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  3. Yazmin Johari
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  4. William W. Kemp
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  5. Stuart K. Roberts
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  6. Wendy A. Brown
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  7. Paul R. Burton
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Corresponding author

Correspondence to Geraldine J. Ooi.

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Disclosures

Geraldine Ooi, Yazmin Johari, Wendy Brown and Paul Burton report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery have control of the protocol, analysis and reporting of any studies. The Centre also receives a Grant from Applied Medical towards educational programs. Wendy Brown reports financial support for a Bariatric Surgery Registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical. Since initial submission of this paper, she has also received a Speaker’s Honorarium from Merck Sharpe and Dohme and a Speaker’s Honorarium and Fees from participation in a Scientific Advisory Board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work. Geraldine Ooi reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons. Andrew Clouston, William Kemp and Stuart Roberts have no conflicts of interest or financial ties to disclose.

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Ooi, G.J., Clouston, A., Johari, Y. et al. Evaluation of the histological variability of core and wedge biopsies in nonalcoholic fatty liver disease in bariatric surgical patients. Surg Endosc 35, 1210–1218 (2021). https://doi.org/10.1007/s00464-020-07490-y

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  • DOI: https://doi.org/10.1007/s00464-020-07490-y

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