Yoel Yosef Siegel MD, Presenter: Nothing to Disclose

James Edward O Donnell MD, Abstract Co-Author: Nothing to Disclose

Patricia Friedmann MS, Abstract Co-Author: Nothing to Disclose

Neil Theise MD, Abstract Co-Author: Nothing to Disclose

Mitchell B. Horowitz MD, Abstract Co-Author: Nothing to Disclose

Radiologist performed, ultrasound guided (USG) liver biopsies, from both left and right lobes, have gained favor due to their relative high yield and low complication rate. Historically, clinicopathologic assessments of staging for prognosis and treatment of hepatitis C have been based on blind percutaneous right lobe biopsies. However, cross-sectional imaging of livers in hepatitis shows uneven morphological changes in disease progression. We therefore compared the stage of hepatitis C scarring and the incidence of sub-capsular sampling in ultrasound guided biopsies of right vs. left hepatic lobes.

Retrospectively, sequential liver biopsy specimens taken between 2000 and 2004 from patients clinically diagnosed with hepatitis C were evaluated by a standard pathologic scale (Ishak score) for disease stage. Patients with comorbid liver disease were excluded. The left and right sided biopies were compared on the basis of hepatitis severity, age, gender, and presence of capsule.

166 patients were included in the study. 72 biopsies were from the left lobe and 94 were from the right. There were no statistically significant differences in age or gender with respect to biopsy side. When comparing left and right sides, 50 (69 %) and 79 (84 %) showed mild disease while 30 (31 %) and 15 (16 %) showed severe disease (i.e. developing or well established cirrhosis), respectively. These differences in stage of disease between the two sides were statistically significant (chi-square; p<0.025). There was no difference between sides in the rate of sampling of subcapsular tissue.

Sampling of the left hepatic lobe results in a significant increase in diagnosis of late stage hepatitis C disease (developing or well established cirrhosis) compared to the right lobe. This difference appears to be related to regional differences in disease progression. This may be important given that historically, clinico-pathologic studies have relied on blind biopsy of the right lobe.

Diagnosis of developing cirrhosis can have profound implications for prognosis and treatment of hepatitis C patients; thus, USG right lobe biopsy may be preferred to avoid overstaging disease.

Siegel, Y, O Donnell, J, Friedmann, P, Theise, N, Horowitz, M, Left Lobe Percutaneous Ultrasound-guided Liver Biopsies from Hepatitis C Patients Leads to Pathologic Overstaging of Disease, Potentially Causing Erroneous Diagnosis and Therapy.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4436414.html