Karaciğer Biyopsisi Yapılmış Hastaların Ön Tanı Ve Son Tanılarının Retrospektif Olarak Değerlendirilmesi
Özet
Introduction and Purpose: Although non-invasive tests are increasingly used in the
evaluation of liver pathologies, liver biopsy continues to have an important role in
the diagnosis of liver diseases. This study aimed to retrospectively examine the
corelation between preliminary diagnosis of patients and final diagnosis after liver
biopsies. In addition, by examining the demographic data in our hospital, which is an
important tertiary reference center, it was aimed to determine the changing trends in
liver disease etiologies and biopsy indications in our country.
Materials and Methods: The study retrospectively evaluated percutanous liver
biopsies (PLB) performed for benign diseases at Hacettepe University Faculty of
Medicine between January 1, 2000 and March 31, 2022.
Results: A total of 1533 patients (52%(n: 789) female and 48% (n:744) male) were
included in the study. The average biopsy age of the patients was 43 years and 11%
(n:121) were cirrhotic. Liver biopsy was repeated more than once (2-4) in 102 (7%)
of the patients with the most frequent indication of evaluating disease activity and
treatment response (63%). PLB was considered insufficient in 28 patients that had
1(0-4) median number of portal areas in their biopsies. The most common indication
for biopsy was elevation in liver enzymes (53.3%) that respectively followed by
evaluation for fibrosis and cirrhosis (40.9%), evaluation of treatment response
(2.7%), and investigation of isolated hepatomegaly (1.6%). The most common
pathology diagnosis was chronic HBV infection 38.6% (n: 591). The frequency of
other pathologies were 11.5% (n:176) chronic HCV infection, 8.5% (n:130)
metabolic disorder-associated steatohepatitis (MASH), 7.7% (n:118) autoimmune
hepatitis (AIH) and %4,2 (n: 64) primary biliary cholangitis. Nonspesific findings
were detected in 19,1% (n:293) of liver biopsy. The clinical preliminary diagnosis
was compatible with the diagnosis received after liver biopsy in 77% of the patients.
A preliminary clinical diagnosis could not be made in 11% (n:170) of the patients.
8
While 6% (n:10) of these patients were diagnosed with PLB, 6 (0.3%) patients were
diagnosed with additional diagnoses by pathology.
When the evaluation was done as two equal periods, namely 2000-2011 and 2012-
2022, there was no change in the rate of chronic HBV (38% and 38.8%; p:0,749).
There was increase in the rates of MASLD (from 6,4% to 10%; p:0,006), OIH (from
3,9% to 11%; p<0,001), and PBC (from 1% to 6,9%; p< 0,001), and OIH-PBC
variant (from 0,2% to 1,1 %; p< 0,001), while chronic HCV decreased from 17,2% to
6,1% (p<0,001), When the diagnoses within 3 years before and after the Corona
Virus Induced Diseases-19 (COVID-19) pandemic were compared, the frequency of
MASLD statistically significantly increased from 6.0% to 25.8% (p<0.001), whereas
chronic HCV and HBV frequencies respectively decreased from 7.1% to 0.5%
(p<0.001) and from 46.2% to 26.9% (p<0.001).
Conclusion: I There was no change in the age and gender distribution in PLB
performed over two decades. However, the Indications for biopsy have evolved from
staging the liver disease and evaluating the presence of cirrhosis towards
determination of underlying etiology. Additionally, there were statistically significant
increase in rates of pathology diagnosis for MASLD and autoimmune liver diseases,
while contrary decrease in that of chronic viral infections.
