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Title: The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury.
Authors: Suzuki, Ayako
Brunt, Elizabeth M
Kleiner, David E
Miquel, Rosa
Smyrk, Thomas C
Andrade, Raul J
Lucena, M Isabel
Castiella, AgustÍn
Lindor, Keith
Björnsson, Einar
metadata.dc.contributor.authoraffiliation: [Suzuki,A] Division of Gastroenterology, Duke University Medical Center, Durham, NC. [Brunt,EM] Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO. [Kleiner,DE] Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Departments of Health and Human Services, Bethesda, MD. [Miquel,R] Department of Pathology, Hospital Clinic, University of Barcelona, Spain. [Smyrk,TC] Departments of Anatomic Pathology and Clinical Pathology, Mayo Clinic, Rochester, MN. [Andrade,RJ] Liver Unit, School of Medicine, University Hospital Virgen de la Victoria, Málaga, Spain. [Andrade,RJ; Lucena,MI] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. [Lucena,MI] Clinical Pharmacology Service, School of Medicine, University Hospital Virgen de la Victoria, Málaga, Spain. [Castiella,A] Digestive Service, Hospital Mendaro, Guipuzcoa, Spain. [Lindor,K] Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. [Björnsson,E] Department of Gastroenterology, University of Iceland, Reykjavík, Iceland.
Keywords: Biopsia;Enfermedad Hepática Inducida por Drogas;Hígado;hepatitis autoinmunitaria
metadata.dc.subject.mesh: Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Surgical::Biopsy
Medical Subject Headings::Diseases::Digestive System Diseases::Liver Diseases::Drug-Induced Liver Injury
Medical Subject Headings::Diseases::Immune System Diseases::Autoimmune Diseases::Hepatitis, Autoimmune
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Anatomy::Digestive System::Liver
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Issue Date: 2-Sep-2011
Publisher: Wiley
Citation: Suzuki A, Brunt EM, Kleiner DE, Miquel R, Smyrk TC, Andrade RJ, et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. Hepatology. 2011; 54(3):931-9
Abstract: Distinguishing drug-induced liver injury (DILI) from idiopathic autoimmune hepatitis (AIH) can be challenging. We performed a standardized histologic evaluation to explore potential hallmarks to differentiate AIH versus DILI. Biopsies from patients with clinically well-characterized DILI [n = 35, including 19 hepatocellular injury (HC) and 16 cholestatic/mixed injury (CS)] and AIH (n = 28) were evaluated for Ishak scores, prominent inflammatory cell types in portal and intra-acinar areas, the presence or absence of emperipolesis, rosette formation, and cholestasis in a blinded fashion by four experienced hepatopathologists. Histologic diagnosis was concordant with clinical diagnosis in 65% of cases; but agreement on final diagnosis among the four pathologists was complete in only 46% of cases. Interface hepatitis, focal necrosis, and portal inflammation were present in all evaluated cases, but were more severe in AIH (P < 0.05) than DILI (HC). Portal and intra-acinar plasma cells, rosette formation, and emperiopolesis were features that favored AIH (P < 0.02). A model combining portal inflammation, portal plasma cells, intra-acinar lymphocytes and eosinophils, rosette formation, and canalicular cholestasis yielded an area under the receiver operating characteristic curve (AUROC) of 0.90 in predicting DILI (HC) versus AIH. All Ishak inflammation scores were more severe in AIH than DILI (CS) (P ≤ 0.05). The four AIH-favoring features listed above were consistently more prevalent in AIH, whereas portal neutrophils and intracellular (hepatocellular) cholestasis were more prevalent in DILI (CS) (P < 0.02). The combination of portal inflammation, fibrosis, portal neutrophils and plasma cells, and intracellular (hepatocellular) cholestasis yielded an AUC of 0.91 in predicting DILI (CS) versus AIH. Conclusion: Although an overlap of histologic findings exists for AIH and DILI, sufficient differences exist so that pathologists can use the pattern of injury to suggest the correct diagnosis.
Description: Comparative Study; Journal Article; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't;
metadata.dc.identifier.doi: 10.1002/hep.24481
ISSN: 1527-3350 (Online)
0270-9139 (Print)
Appears in Collections:01- Artículos - Hospital Virgen de la Victoria

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