Imaging patterns and histological results of liver diseases diagnosed using ultrasound guided liver biopsy at Moi Teaching and Referral Hospital

Abstract

Title: Imaging patterns and histological results of liver diseases diagnosed using ultrasound guided liver biopsy at Moi Teaching and Referral Hospital. Background: Histological assessment of the liver, and thus, 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 being done in only two public facilities in Kenya. The purpose of the study was to document the patterns of liver diseases observed in our setting from ultrasound guided liver biopsies. Objectives: To describe the imaging patterns and histological diagnoses of liver diseases diagnosed by ultrasound guided liver biopsies at Moi Teaching and Referral Hospital. Study site: Moi Teaching and Referral Hospital (MTRH), Radiology and Imaging Department & Histopathology laboratory. Study design: Cross sectional study. Methodology: 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 hospital. A structured data entry form was used to gather all the information. STATA version 12 special edition was used in analysis. Data was analyzed using descriptive statistics. The test for agreement between two raters was done using Kappa test. Results: Hepatocellular carcinoma was 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%). Indication in 74% of the subjects was to establish a diagnosis for suspected malignancy. Conclusions and Recommendation: Hepatocellular carcinoma is the commonest liver malignancy diagnosed in Moi Teaching & Referral Hospital. There is a good agreement between sonographic and histological diagnosis. The major indication for ultrasound guided biopsy is diagnosis for suspicions of hepatocellular carcinoma and metastases to the liver. A follow up study on interventional procedures for management of hepatocellular carcinoma should be conducted.