Our Summary

This study aimed to find a non-invasive way to diagnose non-alcoholic steatohepatitis (NASH), a liver disease, and liver fibrosis (scarring), which currently need a liver biopsy for confirmation. The research involved 250 patients and used a technique called proteomics to study proteins in certain cells, along with flow cytometry, which is a method to measure characteristics of cells. They also used algorithms to predict the presence and stages of NASH.

The study found that an algorithm that used measurements of a protein called PLIN2, along with measurements of waist circumference, triglycerides (a type of fat in the blood), an enzyme called alanine aminotransferase, and the presence or absence of diabetes, was very accurate in diagnosing NASH. This algorithm correctly diagnosed NASH in 93% of cases in the first group of patients and 92% in the second group.

Another algorithm was very accurate in diagnosing liver fibrosis. This algorithm used measurements of a protein called RAB14, along with age, waist circumference, good cholesterol levels, blood sugar levels, and levels of the same enzyme. This algorithm was correct in 99.25% of cases in the first group and 97.6% in the second group.

The researchers conclude that these new methods for diagnosis are accurate and reliable, more so than current methods. They propose that this “liquid biopsy” could be used to diagnose NASH and liver fibrosis.

FAQs

  1. What is the goal of this study on liver biopsy?
  2. How accurate were the algorithms used in diagnosing NASH and liver fibrosis?
  3. What proteins and other measurements were used in the algorithms for diagnosing NASH and liver fibrosis?

Doctor’s Tip

A doctor might tell a patient that a liver biopsy is currently the gold standard for diagnosing liver diseases like NASH and liver fibrosis, but new research is showing promising results with non-invasive methods. They might explain that these new methods involve analyzing proteins and other markers in the blood, which can provide accurate and reliable results without the need for a biopsy. They might suggest discussing these new options with a healthcare provider to see if they are a suitable alternative for diagnosing liver conditions.

Suitable For

Patients who are typically recommended for a liver biopsy include those with suspected liver diseases such as NASH, liver fibrosis, hepatitis, cirrhosis, or liver cancer. Additionally, patients with abnormal liver function tests, unexplained liver enlargement, unexplained jaundice, or unexplained abdominal pain may also be recommended for a liver biopsy. Patients with risk factors such as obesity, diabetes, high cholesterol, or a history of heavy alcohol use may also be candidates for a liver biopsy.

Timeline

Before a liver biopsy:

  1. Patient presents with symptoms such as fatigue, abdominal pain, jaundice, or abnormal liver function tests.
  2. Patient undergoes blood tests and imaging studies to evaluate liver function and structure.
  3. If non-invasive tests suggest liver disease, patient may be recommended for a liver biopsy.
  4. Patient undergoes counseling and informed consent process for the liver biopsy procedure.

After a liver biopsy:

  1. Patient is prepped for the procedure and given local anesthesia.
  2. A needle is inserted into the liver to obtain a tissue sample.
  3. Patient may experience some discomfort or pain during the procedure.
  4. After the biopsy, patient is monitored for a few hours to ensure there are no complications such as bleeding.
  5. Results from the biopsy may take a few days to come back, and treatment is determined based on the findings.
  6. Patient may experience some pain or discomfort at the biopsy site for a few days after the procedure.
  7. Follow-up appointments are scheduled to monitor the patient’s liver health and response to treatment.

What to Ask Your Doctor

Some questions a patient should ask their doctor about liver biopsy include:

  1. What is the purpose of the liver biopsy and what information will it provide about my condition?
  2. What are the risks and potential complications associated with a liver biopsy?
  3. Are there alternative non-invasive methods for diagnosing NASH and liver fibrosis that I could consider?
  4. How accurate are the current methods for diagnosing NASH and liver fibrosis compared to the new “liquid biopsy” method described in this study?
  5. How will the results of the liver biopsy impact my treatment plan and prognosis?
  6. How long will it take to receive the results of the liver biopsy?
  7. Are there any specific preparations or restrictions I need to follow before undergoing a liver biopsy?
  8. How experienced is the healthcare provider performing the liver biopsy and what is their success rate?
  9. Are there any specific follow-up steps or monitoring that should be done after the liver biopsy?
  10. Are there any additional tests or procedures that may be recommended based on the results of the liver biopsy?

Reference

Authors: Angelini G, Panunzi S, Castagneto-Gissey L, Pellicanò F, De Gaetano A, Pompili M, Riccardi L, Garcovich M, Raffaelli M, Ciccoritti L, Verrastro O, Russo MF, Vecchio FM, Casella G, Casella-Mariolo J, Papa L, Marini PL, Rubino F, le Roux CW, Bornstein S, Mingrone G. Journal: Gut. 2023 Feb;72(2):392-403. doi: 10.1136/gutjnl-2022-327498. Epub 2022 Jul 12. PMID: 35820779