Clinical

Liver biopsies can't assess chemotherapy injury

Last Updated: 2012-08-28 14:00:27 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Liver biopsies can't be used to assess chemotherapy associated liver injuries (CALIs), Italian researchers say.

These injuries "worsen outcomes of liver resection by increasing postoperative morbidity and mortality," Dr. Luca Vigan� told Reuters Health by email. "However, preoperative CALI assessment is not currently achievable."

"The present prospective study demonstrated that even preoperative liver biopsy is not a reliable tool for CALI evaluation," he said.

As reported online August 20th in Archives of Surgery, Dr. Vigan� and colleagues at Ospedale Mauriziano Umberto I, Turin studied 100 patients with colorectal metastases who had received at least four cycles of oxaliplatin or irinotecan-based chemotherapy. All underwent parenchymal biopsy before liver resection.

Blinded CALI evaluation was performed on biopsy and resection specimens. Biopsy findings correctly predicted steatosis (sensitivity, 88.9%; accuracy, 93.0%). But for sinusoidal dilatation, the sensitivity and accuracy of biopsy findings were only 21.4% and 63.0%, respectively.

Predictions for hepatocellular ballooning also had low sensitivity and accuracy (16.0% and 69.0%) as did those for lobular inflammation (20.0% and 78.0%), and steatohepatitis (21.1% and 79.0%).

The operative mortality rate in the 19 patients with steatohepatitis was 10.5%. There was no mortality in other patients, and accordingly no other variables correlated with mortality.

The team says biopsies could be expected to be more reliable in "patients with higher prevalence of CALIs, such as those with more toxic chemotherapy regimens, prolonged treatments, or obesity" - but even in those groups, accuracy was no better.

Therefore, Dr. Vigan� says, "Liver biopsy should not be included in the preoperative work-up of patients with colorectal metastases who are scheduled for resection after preoperative chemotherapy."

Dr. Timothy M. Pawlik, co-author of an editorial published with the report, told Reuters Health by email, "The authors found that only about one-quarter of patients had any evidence of severe liver injury after receiving chemotherapy for colorectal liver metastasis. As such, while severe chemotherapy-associated liver injury may be a concern, it is relatively uncommon especially among patients who are treated with short courses of chemotherapy."

Dr. Pawlik of The Johns Hopkins University, Baltimore, Maryland added, "It is, therefore, not surprisingly that the authors recommend against routine use of needle biopsy since the very thing the needle biopsy is seeking to detect is relatively uncommon."

"Whether in high-risk populations -- such as those with diabetes, obesity, pre-existing fatty liver disease -- the selective use of needle biopsy to assess chemotherapy induced liver injury should be used remains unanswered and a topic of some controversy," he added.

But in general, Dr. Pawlik concluded, "patients can safely undergo liver resection after receiving short duration chemotherapy before their liver operation."

SOURCE: http://bit.ly/SNW5CO

Arch Surg 2012.