25Aug 2017

CORRELATION AMONG CLINICAL INDICATIONS, IMAGING PATTERNS AND HISTOPATHOLOGY OF LIVER LESIONS IN PATIENTS REFERRED FOR ULTRASOUND GUIDED LIVER BIOPSIES AT MOI TEACHING AND REFERRAL HOSPITAL (MTRH), KENYA.

  • Department of Radiology and Imaging, School of Medicine, College of Health Sciences, Moi University, P. O. Box 4606-30100, Eldoret, Kenya,
  • Department of Pathology and Forensic Medicine, School of Medicine, College of Health Sciences,Moi University, P. O. Box 4606-30100, Eldoret, Kenya.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: Liver biopsy is a core investigation tool in the evaluation and subsequent management of patients with liver neoplasms or inflammatory conditions. Liver biopsy is useful in making diagnosis, assessing the prognosis of liver diseases and in making decisions for therapeutic management. Interventional radiology is a rapidly growing subspecialty, with very few personnel generally, more so in developing countries. Ultrasound guided percutaneous liver biopsy is currently being done in only two public facilities in Kenya. This study evaluated the clinical indications, imaging and histopathological diagnosis of liver diseases observed in our setting from ultrasound guided liver biopsies. Objectives: To describe the clinical indications, imaging patterns and histopathological diagnoses of liver diseases diagnosed by ultrasound guided liver biopsies at Moi Teaching and Referral Hospital. Methods: This was a cross sectional study done at the Moi Teaching and Referral Hospital (MTRH) in Kenya, in the departments of Radiology &Imaging and Histopathology. All consenting patients referred for ultrasound guided liver biopsy were studied with a sample size of 36 patients, over one year period. Data was collected prospectively from the patients. A structured data entry form was used to gather all the information. Data was analyzed using descriptive statistics with the aid of STATA version 12 special edition. The test for agreement between two raters was done using Kappa test. Results: The working clinical diagnosis from the referring clinician showed that 22(63%) participants had hepatocellular carcinoma (HCC), 1(3%) had hydatid, 1(3%) had an incidental finding, 3(9%) had lymphoma, 1(3%) and 7(20%) had metastasis. On the histopathology results, HCCwas the commonest pathology that was diagnosed (n=21). Most HCC lesions were larger than 5cm (n=18, 90%) and 85% of these lesions were heterogeneous on sonography. There was a moderately strong kappa value (kappa=0.511) for the level of agreement between sonographic and histological diagnosis of liver cancer. The only complication was pain (n=21, 60%).

  1. Sherlock S. Aspiration liver biopsy, technique and diagnostic application Lancet 1945; ii:397.
  2. Reuben A. Just a secondHepatology 2003;38:1316-1320.
  3. SpiliosM,Christos T, Sotirios B, Jiannis T, Jiannis V, Evangelos C, Markos S,? Calipso B, Ploutarchos P, Charis S, Nikolaos R, Dimitrios T, Alec A? &Andrew BUltrasound-guided liver biopsy in real life: Comparison of same-day prebiopsy? versus real-time ultrasound approach? Journal of Gastroenterology and Hepatology? 22 (2007) pg 1493
  4. Jean-Franc? Pierre R, and Franc O. Practices of Liver Biopsy in France: Results of a Prospective Nationwide Survey Hepatology 2000; 32: 480
  5. Morisod J, Fontolliet C, Haller E, Gardiol D, Hofstetter JR, Gonvers JJ.Current role of biopsy in the diagnosis of hepatic disease.Schweiz Med Wochenschr. 1988; 118:125?33.
  6. World Gastroenterology Organisation Global Guideline: Hepatocellular carcinoma (HCC): a global perspective .November 2009
  7. N. Tenge, R.T. Kuremu, N.G. Buziba, K. Patel And P. A. WereBurden and Pattern of Cancer In Western KenyaEast African Medical Journal Vol. 86 No. 1 January 2009
  8. Mutuma G.Z, Mbuchi M, Zeyle E, Fasana R, Okoth F, Kabanga M, Kuria J, Shiramba L, Njenga K, Kaiguri P, Osidiana V. Prevelance of Hepatitis B Virus(HBV) surface antigenand HBV assosiated hepatocellular carcinomain Kenyans of various ages. Afr J Health Sci 2011; 18:53-61
  9. Don C. Rockey, Stephen H. Caldwell, Zachary D. Goodman, Rendon C. Nelson, and Alastair D. Smith.AASLD position paper on liver biopsyHepatology, Vol. 49, No. 3, 2009
  10. Gilmore IT, Burroughs A, Murray-Lyon, Roger Williams, D Jenkins, A Hopkins.Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London.Gut?1995 Mar;36 (3):437-41
  11. Shiramba TL1,Lodenyo HA,?Kabanga JM,?Kuria JK.? Diagnostic?utility?of fine-needle aspiration cytology in the management of liver ??????? disease in a district hospital.East Afr Med J.?2010 Apr;87 (4):163-6
  12. Hamazaki K, Matsubara N, Mori M, Gochi A, Mimura H, Orita KNeedle tract implantation of hepatocellular carcinoma after ultrasonically guided needle liver biopsyHepatogastroenterology. 1995;42:601?6.
  13. Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practiceGut 45 (Suppl 4): IV1?IV11. doi:1136/gut.45.2008.iv1. PMC1766696.
  14. Caldironi MW, Mazzucco M, Aldinio MT, Paccagnella D, Zani S, Pontini F.Echo-guided fine-needle biopsy for the diagnosis of hepatic angiomaMinerva Chir. 1998;53:505?9.
  15. Landis J.R. & Koch Gary, Measurement of Observer Agreement for Categorical DataBiometrics Vol 33, 159-174, 1977.
  16. Mwangi J, Gatei DG. Hepatitis B virus, hepatocellular carcinoma and liver cirrhosis in Kenya. East Afr Med J. 1993 Apr;70(4 Suppl):34-6.
  17. Tanioka H1, Omagari K, Kato Y, Nakata K, Kusumoto Y, Mori I, Furukawa R, ???????? Tajima H, Koga M, Yano M, Kohno S. Present status of hepatitis virus-associated hepatocellular carcinoma in Nagasaki Prefecture, Japan: a cross-sectional study of 1019 patients.
  18. Kew, M. C. Clinical, pathologic, and etiologic heterogeneity in hepatocellular carcinoma: Evidence from Southern Africa.Hepatology, 1:?366?369. doi:?10.1002/hep.1840010415
  19. Karoney M. J. &Siika A. M. Hepatitis C virus (HCV) infection in Africa: a review. Pan African Medical Journal 2013;14:44
  20. Lopez JB, Balasegaram M, Thambyrajah V, Timor J. The value of liver function tests in hepatocellular carcinoma. Malaysian Journal of Pathology. 1996 Dec;18 (2):95-9
  21. John Ryan, David J. Straus, Carl L, Daniel A. Filippa, Jose F., Linda M.Sanders, Man H. Shiu, Joseph G. Fortner. Primary Lymphoma Of The Liver.? Cancer, 29 Jun 2006; ?61:2
  22. Sherlock S, Dooley J. Diseases of the liver and biliary system10th edn. London: Blackwell Scientific, 1997.
  23. Newman TB. And Kohn MA. Evidence-Based Diagnosis. Cambridge University Press, New York, 2009.
  24. MedizinischeKlinik, KreiskrankenhausB?blingen. Ultrasound diagnosis of hepatocellular carcinoma.Bildgebun 1993 Mar;60(1):18-22

[SitieneiLoice, MBChB, MMed;Abuya Joseph, MBChB, MMed and Chumba David, MBChB, MMed. (2017); CORRELATION AMONG CLINICAL INDICATIONS, IMAGING PATTERNS AND HISTOPATHOLOGY OF LIVER LESIONS IN PATIENTS REFERRED FOR ULTRASOUND GUIDED LIVER BIOPSIES AT MOI TEACHING AND REFERRAL HOSPITAL (MTRH), KENYA. Int. J. of Adv. Res. 5 (Aug). 1599-1609] (ISSN 2320-5407). www.journalijar.com

Abuya Joseph
1. Department of Radiology and Imaging, School of Medicine, College of Health Sciences, Moi University, P. O. Box 4606-30100, Eldoret, Kenya.

DOI:

Article DOI: 10.21474/IJAR01/5220      
DOI URL: https://dx.doi.org/10.21474/IJAR01/5220

Download Full Paper

Download PDF No. of Downloads: 17 | No. of Views: 110