Usefulness of liver biopsy for CALI preoperative assessment questioned

By Ingrid Grasmo, medwireNews Reporter

Liver biopsy is not a reliable tool for preoperative assessment of chemotherapy-associated liver injuries (CALIs) except for steatosis, suggest study findings published in the Archives of Surgery.

With the increasing use of preoperative chemotherapy for colorectal liver metastases, there is growing concern that CALIs may be more prevalent and, in turn, adversely affect perioperative outcomes.

"Although [the researchers] provide compelling data against the routine use of needle biopsy, the study does not conclusively answer perhaps the more relevant clinical question: Should needle biopsy be used selectively in a population with a suspected higher prevalence of CALIs?," say Timothy Pawlik (Johns Hopkins University, Baltimore, Maryland, USA) and Jean-Nicolas Vauthey (University of Texas MD Anderson Cancer Center, Houston, USA) in an invited critique.

"Whether in high-risk populations the selective use of needle biopsy to assess CALIs lacks any clinical efficacy and therefore should be universally abandoned remains a topic of controversy," add Pawlik and Vauthey.

Assessment of the sensitivity, specificity, and accuracy of liver biopsy in CALI evaluation of specimens from 100 patients with colorectal metastases who received preoperative oxaliplatin and/or irinotecan-based chemotherapy (four or more cycles) showed that biopsy findings correctly predicted only steatosis with a sensitivity and accuracy of 88.9% and 93.0%, respectively.

Grade 2 or 3 steatosis was diagnosed in 30 patients, grade 2 or 3 sinusoidal dilatation in 28 patients, grade 2 or 3 lobular inflammation in 25 patients, steatohepatitis in 19 patients, and grade 2 hepatocellular ballooning in three patients.

Biopsy findings had low sensitivity and accuracy for sinusoidal dilatation (21.4 and 63.0%), hepatocellular ballooning (16.0 and 69.0%), lobular inflammation (20.0 and 78.0%), and steatohepatitis (21.1 and 79.0%).

Luca Vigano (Ospedale Mauriziano Umberto I, Torino, Italy) and colleagues note that the poor value of biopsy in CALI assessment is exemplified by steatohepatitis, for which 15 of 19 cases were missed: "These results are likely related to the nonhomogeneous distribution of the injuries throughout the liver."

Oxaliplatin administration was found to be associated with higher sinusoidal dilatation grade, which was said to be most likely related to tissue distortion following biopsy.

Biopsy results did not improve among patients with a higher prevalence of CALIs, such as those with more toxic chemotherapy regimens, prolonged treatments, or obesity despite improved results expected for this group of patients.

"Preoperative liver biopsy is not a reliable tool with which to evaluate CALIs… [and] should not be included in the preoperative workup," conclude the researchers.

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