title: Will a second biopsy sample affect treatment decisions in patients with chronic hepatitis B?
abstract: OBJECTIVE
  Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B.
  
  
  METHODS
  27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system.
  
  
  RESULTS
  Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found.
  
  
  CONCLUSIONS
  With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.
authors.affiliation: Department of Gastroenterology, Hatay Antakya State Hospital, Saraykent mh. 20.sk, Antakya, Hatay, Turkey. dr_ekiz@yahoo.com.
authors.forename: Fuat
authors.initials: F
authors.lastname: Ekiz
authors.affiliation: Department of Gastroenterology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: İlhami
authors.initials: İ
authors.lastname: Yuksel
authors.affiliation: Department of Pathology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey.
authors.forename: Ata Turker
authors.initials: AT
authors.lastname: Arikök
authors.affiliation: Department of Gastroenterology, Osmaniye State Hospital, Osmaniye, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Yilmaz
authors.affiliation: Department of Gastroenterology, Ankara Numune Educational and Research Hospital, Ankara, Turkey.
authors.forename: Akif
authors.initials: A
authors.lastname: Altinbas
authors.affiliation: Department of Gastroenterology, Ankara Kecioren Educational and Research Hospital, Ankara, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Aktas
authors.affiliation: Department of Gastroenterology, Yozgat State Hospital, Yozgat, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Deveci
authors.affiliation: Department of Gastroenterology, School of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Basar
authors.affiliation: Department of Gastroenterology, Diskapi Yildirim Beyazit Educational and Research Hospital, Ankara, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Coban
authors.affiliation: Department of Gastroenterology, School of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Yuksel
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D003657:Decision Making; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013048:Specimen Handling
keywords: Chronic hepatitis B; Liver biopsy; Sample variability