Asian Pac. J. Health Sci., 2019; 6(2):70-77 e-ISSN: 2349-0659, p-ISSN: 2350-0964 ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ Bashir et al ASIAN PACIFIC JOURNAL OF HEALTH SCIENCES, 2019;6(2):70-77 70 www.apjhs.com Document heading doi: 10.21276/apjhs.2019.6.2.9 Research Article Impact of the size of liver biopsies on the evaluation of chronic liver disease –a study by artificial sampling Naheena Bashir 1 ,Zubaida Rasool 2 ,Duri Mateen 1 1 MD Pathology,Senior Resident,Department of Pathology,SKIMS,Soura,Srinagar 2 MD Pathology,Additional Professor, Department of Pathology,SKIMS,Soura,Srinagar Received: 28-01-2019 / Revised: 27-03-2019 / Accepted: 30-04-2019 Abstract Chronic liver disease is a disease process of the liver that involves progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. We first evaluated the 70 percutaneous liver biopsies from patients with a clinically established diagnosis of chronic hepatitis and chronic liver diseases of various etiologies. All biopsies were obtained through percutaneous approach using 16 F biopsy gun (manufactured by Bard) in adults and 18 F in children. . The mean biopsy size was 1.8cm ± 0.20 and a median size was 2cm. Out of the 70 liver biopsies, a total of 24 (34.2%) liver biopsies were less than 1.5cm in size, and 46(65.7%) were ≥ 1.5cm. Keywords:biopsy,chronic,liver,disease Introduction Chronic liver disease is a disease process of the liver that involves progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. Chronic liver disease (CLD) is the major cause of morbidity and mortality worldwide. More recently, the increasing prevalence of obesity and the metabolic syndrome has resulted in increasing incidence of cirrhosis secondary to nonalcoholic fatty liver disease (NAFLD), especially in developed countries[1]. Viral hepatitis is the most common cause of acute and chronic liver disease in the world with over half the world’s population exposed to the different hepatotropic viruses[2].Approximately 18% of patients with auto-immune liver disease present with features characteristic of a second auto-immune hepatobilliary disease, usually Primary Biliary Cirrhosis (PBC) or Primary Sclerosing Cholangitis (PSC)[3]. Inspite of recent advances in non- invasivetechniques, liver biopsy continues to be the gold standard method in evaluating chronic hepatitis and fibrosis[4]. Correspondence Dr. Naheena Bashir Senior Resident,Department of Pathology, SKIMS,Soura,Srinagar E Mail: naheena786@gmail.com Materials & methods This was a prospective study carried out over a period of 2 years extending from June 2013 to June 2015. We first evaluated the 70 percutaneous liver biopsies from patients with a clinically established diagnosis of chronic hepatitis and chronic liver diseases of various etiologies. All biopsies were obtained through percutaneous approach using 16 F biopsy gun (manufactured by Bard) in adults and 18 F in children. All samples ≥ 1.5cm were reviewed blindly at two different sessions, changing the length of the sample with the aid of opaque paper tape [Artificial Sampling, (AS)]so that only specific specimen lengths (5 mm, 10mm) were visible. All the parameters including the diagnosis, scoring and staging of the various diseases were repeated by reducing the length of the specimen from ≥1.5 cm to 1 cm (AS1) and further to 0.5cm (AS2). The Ishak’s scoring system[5] was used for grading and staging of chronic hepatitis. For NASH, Kleiner’s score was used and staging in primary biliary cirrhosis was done by Ludwig’s method[6,7]. Statistical analysis For assessing the impact of length on the scoring and fibrosis, agreement between the 5-mm, 10-mm, with the 15-mm or greater length was estimated by using weighted κ statistics. The statistical evaluation was based on the prerequisite that the biopsy length of 1.5cm or greater was the gold standard, and that smaller biopsy specimens were compared with that