The Pre-Fibroscan and Fibroscan Era: A Comparative Study of Histologic Diagnosis of Liver Biopsies

The advancement in non-invasive methods for diagnosing and characterizing liver disease has achieved significant success. One such methods, FibroScan, combines non-invasiveness, rapidity, painlessness, and reproducibility. However, its accuracy and value are limited in many clinical settings. The liver biopsy, the gold standard for assessing liver fibrosis offers direct visualization and provides extensive information through histology and ancillary investigations a noticeable gap of Fibroscan and other non-invasive methods.

To determine the rate of histology requests by gastroenterologists and surgeons at the Jos University Teaching Hospital during the pre-FibroScan era and the FibroScan era in the Jos metropolis.

Patient biodemographic information and histologic diagnoses, along with the category of the requesting physician (gastroenterologist or surgeon) for liver biopsies, were extracted from hospital records. Data were collated for the pre-FibroScan era (2004-2010) and the FibroScan era (2011-2023), spanning 20 years. All patients with liver biopsies submitted for histologic analyses were included while those with inadequate biodemographic data, histologic diagnoses, and category of requesting physician were excluded.

Two hundred and eighteen (218) liver biopsies were received during the study of the period. Of these, two hundred and eight (95.4%) met the study criteria, with 111 (53.4%) from the pre-FibroScan era and 97 (46.6%) from the FibroScan era. In the pre-Fibroscan era,110(99.09%) 1(0.01%) histology requested were by gastroenterologist and surgeons respectively, while in the Fibroscan era the respective requests by these specialties were 36(37.11%) and 97(62.89%). The first year of the Fibroscan era (2011) accounted for 22(61.11%) of the 36(100.00%) cases liver biopsies requested by gastroenterologist, with a corresponding value of 11(16.67%) of 66(100.00%) for surgeons. The significance concerning the requesting physician's specialty with p-value of 0.003.

For the foreseeable future, the FibroScan cannot replace the value of direct tissue histological assessment, especially where molecular studies and other ancillary investigations are crucial for targeted therapy and research. Histology remains the gold standard for the aforementioned reasons and probably will until the non-invasive investigations can provide the myriads of valuable information it avails.