Karaciğer Biyopsisi Yapılmış Hastaların Ön Tanı Ve Son Tanılarının Retrospektif Olarak Değerlendirilmesi

Abstract

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.

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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.