Liver biopsy quality criteria to exclude cirrhosis in case of suspicion of porto-sinusoidal vascular disorder
Year: 2025
Type: article
Abstract: Background & Aims: Baveno VII guidelines based porto-sinusoidal vascular disorder (PSVD) diagnosis on a liver biopsy excluding cirrhosis. However, evidence-based quality criteria for liver biopsy are lacking. This study aimed to determine biopsy length and staining appropriate to rule out cirrhosis. Methods: Liver explants from 12 patients with cirrhosis and 12 with PSVD were selected. Slides were stained with Picrosirius red or Masson's trichrome. A total of 36,000 virtual liver biopsies were randomly generated, including different biopsy widths (572 and 1,000 μm corresponding to transjugular and percutaneous biopsies, respectively) and lengths (5 mm, 10 mm, 15 mm, 20 mm, 25 mm; fragmented 5 + 10 mm and 5 + 5 + 5 mm). Biopsies were assessed by an expert pathologist for the presence or absence of cirrhosis. Results: <0.001). A plateau was also observed from 15 mm for transjugular biopsies. Fragmented biopsies with at least one 10-mm-long fragment (5 + 10 mm) had similar sensitivity as 15-mm-long biopsies. Diagnostic accuracy was lower in case of Laennec A cirrhosis, HBV-associated disease, or incomplete septal fibrosis. Validation by a second pathologist gave similar results. Conclusions: For the diagnosis of PSVD, the minimum length of liver biopsy to exclude cirrhosis was 15 mm with at least one fragment of 10 mm. Picrosirius red had a better performance than Masson's trichrome staining. The transjugular route showed lower sensitivity, but provides additional information. Impact and implications: This study shows that, for the diagnosis of porto-sinusoidal vascular disorder, the minimum length of liver biopsy to exclude cirrhosis is 15 mm, with a minimum fragment of 10 mm. Picrosirius red had a slightly better performance than Masson's trichrome staining. Future guidelines might consider that a ≥15-mm-long biopsy, with a fragment ≥10 mm, is sufficient to rule out cirrhosis in case of suspicion of porto-sinusoidal vascular disorder with signs of portal hypertension.
Source: JHEP Reports
Institutions: Inserm, Université Paris Cité, Hôpital Beaujon, Assistance Publique – Hôpitaux de Paris, Centre de Recherche sur l'Inflammation, Agència de Gestió d'Ajuts Universitaris i de Recerca, Centro de Investigación Biomédica en Red, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centre Hospitalier Universitaire de Tours, Hôpital Foch
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,110
Funders: European Commission, European Cooperation in Science and Technology, Agence Nationale de la Recherche, Institut National de la Santé et de la Recherche Médicale, Fondation pour la Recherche Médicale, Fondation ARC pour la Recherche sur le Cancer, Universitat de Barcelona, Société Nationale Française de Gastro-Entérologie, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Horizon 2020 Framework Programme, Agència de Gestió d'Ajuts Universitaris i de Recerca
Awards: G1190173965, DECOMPENSATED CIRRHOSIS: IDENTIFICATION OF NEW COMBINATORIAL THERAPIES BASED ON SYSTEMS APPROACHES, TimE frame ControL of Inflammation by canonical and non-canonical autophagy to Prevent fatty liver diSease progrEssion, G265113304, G3590233067, G3711061403, G4077682647, G4656594441, G4667364679, G5069008410, G5186833093, Deciphering HEArt-liVEr commuNication in nonalcohoLic fattY liver disease, G7092491396, G7259991030, exTRACellular vesicles as biomarKers, European Joint Programme on Rare Diseases, G8450073163, G8471630636, Université de Paris, G8886375882
OpenAlex ID: W4416101117