Halit BAY, Aydan KANSU, Zarife KULOĞLU, Ceyda Tuna KIRSAÇLIOĞLU, Aytaç YAMAN

Çocuklarda Karaciğer Hastalıklarının Tanısında Karaciğer Biyopsisinin Yeri

Amaç: Merkezimizde yapılmış olan karaciğer biyopsileri endikasyon, klinik ve laboratuvar veriler, ön tanı ve histopatolojik tanılar açısından analiz edilerek elde edilen klinik ve laboratuvar verileriyle, karaciğer biyopsisinin tanıdaki etkinliğinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışma, 2008-2017 yılları arasında yenidoğan kolestazı, kronik karaciğer hastalığı, izole hipertransaminazemi, izole hepatomegali ve ultrasonografik parankimal bulgularla karaciğer biyopsisi yapılan 0-18 yaş grubundaki hastaların demografik, fizik inceleme, laboratuvar ve ultrasonografi bulguları, biyopsi endikasyonları ve histopatolojik tanı bilgilerinin geriye dönük incelenmesiyle yürütülmüştür. Hastalar, ön tanısı olan, ön tanının doğrulanması amacıyla karaciğer biyopsi yapılanlar (Grup 1) ve klinik ve laboratuvar olarak ön tanısı olmayan, tanı amacıyla biyopsi yapılanlar (Grup 2) olarak ikiye ayrılarak değerlendirilmiştir. Bulgular: Yaş ortalaması 8,8±5,7 olan, 139’u (%53) erkek olan 262 hasta çalışmaya alınmıştır. Hastaların 183’ü (%69,8) Grup 1’de, 79’u (%30,2) Grup 2’de bulunmaktadır. Grup 1’de hastaların %87,4’ünde, Grup 2’de hastaların %26,6’sında kesin tanıya ulaşılmıştır. Biyopsiyle tanı elde edilebilmesinde ön tanı varlığı (p=0,001), fiziksel incelemede hepatomegali saptanması (p=0,001), splenomegali saptanması (p=0,001) ve ultrasonografide karaciğer parankiminde patoloji saptanması (p=0,008) istatistiksel olarak anlamlı bulunmuştur. Sonuç: Tüm hasta grubumuzda, hastaların %69,1’i kesin tanı almıştır. Ön tanı varlığının histopatolojik olarak kesin tanı elde edebilmede istatistiksel olarak anlamlı olduğu görülmüştür. Ancak verilerimiz sonucunda klinik, laboratuvar ve görüntüleme yöntemleriyle ön tanıya gidilemeyen hastalarda da karaciğer biyopsisinin riskleri ve spesifik bir tanı elde etmedeki yararları göz önünde bulundurularak, hasta özelinde biyopsi kararı verilmesinin uygun olacağı düşünülmüştür.

Role of Liver Biopsy in the Diagnosis of Liver Diseases in Children

Objectives: It was aimed to determine the diagnostic efficacy of liver biopsy with clinical and laboratory data by analyzing liver biopsies performed in our center in terms of indication, clinical and laboratory data, pre-diagnosis and histopathological diagnoses. Materials and Methods: The study was conducted by retrospectively examining demographic, physical examination, laboratory, ultrasonography findings, biopsy indications and histopathological diagnosis information of patients aged 0-18 years, who underwent liver biopsy with neonatal cholestasis, chronic liver disease, isolated hypertransaminasemia, isolated hepatomegaly and ultrasonographic parenchymal findings between 2008 and 2017. The patients were evaluated by dividing into two groups: those who underwent liver biopsy to confirm the pre-diagnosis (Group 1), and those without pre-diagnosis and underwent biopsy for diagnostic purposes (Group 2). Results: A total of 262 patients (mean age: 8.8±5.7 years, 53% male), including 183 (69.8%) in Group 1 and 79 (30.2%) in Group 2, were included. The definitive diagnosis was reached in 87.4% and 26.6% in two groups, respectively. Presence of pre-diagnosis (p=0.001), hepatomegaly (p=0.001), splenomegaly (p=0.001) on physical examination and detection of liver parenchymal pathology with ultrasonography (p=0.008) were found to be statistically significant in obtaining a definitive diagnosis with biopsy. Conclusion: In our entire patient group, 69.1% of the patients were definitively diagnosed. Presence of pre-diagnosis was found to be statistically significant in obtaining a histopathologically definitive diagnosis. However, based on our data, we thought that it would be appropriate to make a biopsy decision considering the risks and the benefits of liver biopsy in patients without pre-diagnosis.

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