Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injuries Biopsy of Chemotherapy-Associated Liver Injuries

Viganò L, Ravarino N, Ferrero A, et al. — Sat, 01 Dec 2012 00:00:00 GMT

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 2 or 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.

Preoperative Biopsy Evaluation of Chemotherapy-Associated Liver Injuries Looking for a Needle in a Haystack? Comment on “Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injury” Preoperative Biopsy Evaluation of CALI

Pawlik TM, Vauthey J. — Sat, 01 Dec 2012 00:00:00 GMT

We read with great interest the study by Viganò et al regarding the use of preoperative biopsy to evaluate chemotherapy-associated liver injuries (CALIs). With the increasing use of preoperative chemotherapy, concern has grown that CALIs may be more prevalent and, in turn, adversely affect perioperative outcomes.

JAMA Surgery: Adverse Drug Effects Topic Collection

Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injuries Biopsy of Chemotherapy-Associated Liver Injuries

Preoperative Biopsy Evaluation of Chemotherapy-Associated Liver Injuries Looking for a Needle in a Haystack? Comment on “Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injury” Preoperative Biopsy Evaluation of CALI