"Where Does This Specimen Even Go?" An Institutional Experience on the Evaluation of Adequacy and a Model for Tissue Collection and Processing of EUS-Guided Liver Biopsies Collected for the Evaluation of Medical Liver Disease

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Lab Invest

Abstract

Background: EUS-Guided Fine Needle Liver Biopsy (EUS-FNLB) utilizing high yield needles has been accepted by gastroenterologists for the assessment of medical liver diseases (MLD). Still, hesitancy remains in pathology regarding whether EUS-FNLB samples are sufficient to assess MLD given the American Association for the Study of Liver Disease (AASLD) recommendation of at least 11 portal tracts and at least 1.5 cm length. Furthermore, these samples straddle the space between cytology and surgical pathology, raising questions about how to process these specimens. As such, the goal of this study is to compare these specimens at our institution to AASLD adequacy criteria and present a model of tissue processing and evaluation. Design: We reviewed a total of 47 EUS-FNLB specimens collected for MLD assessment at our institution between April 2022 and August 2023. Collection methods, processing, clinical and histologic parameters were recorded. All cases were reviewed by at least 2 liver pathologists. All specimens were collected with 19 Gauge, heparin primed, Boston Scientific Acquire FNB needles. All samples were fixed at least 1 hour and processed for H&E and routine histochemical stains. Results: At the time of processing, a pathology assistant identified tissue cores and submitted them separately from clot with 23 (49%) submitted with 1 block and 24 (52%) submitted with 2 or more blocks (range 2-5 blocks) (Figure 1). Varices were assessed on all patients and detected on 11 (23%). Portal pressure gradients could be collected on 36 (73.5%). Concurrent GI biopsies were taken on 24 (51%). 1 (2%) was inadequate (no liver tissue to evaluate). Of the remaining 46 cases, 42 (93.5%) meet AASLD adequacy criteria (2 (4.3%) had an aggregate length less than 1.5 cm, 3 (18.8%) had less than 11 portal tracts sampled). All specimens had least 1 tissue fragment with at least 3 portal tracts (range 2 - 27 fragments) allowing for the assessment of architecture. Interestingly, 11 (24%) had at least one fragment 1.5 cm or greater. Samples were only reviewed by GI pathologists who routinely assessed liver biopsy samples. Conclusions: EUS-FNLB offers the ability to diagnose MLD, collected relevant clinical parameters, biopsy and manage stents. Despite acceptance by gastroenterologists, pathologists remain wary. Our study demonstrates that adequate tissue meeting AASLD guidelines can be collected and an accurate diagnosis rendered. We also provide our process for processing EUS-FNLB through surgical pathology.

Volume

104

Issue

3

First Page

S1636

Find It @ Sladen

Share

COinS