Review for 10.1186/s12876-025-03646-z (2025)

Title: A Comprehensive Analysis of Percutaneous Liver Biopsy Characteristics and
Pathological Manifestations in a Large Patient Cohort (2009-2024)
Version: 4 Date: 04 Jan 2025
Reviewer:  Suzan Hamed
Reviewer's report:
This article of" A Comprehensive Analysis of Percutaneous Liver Biopsy Characteristics and
Pathological Manifestations in a Large Patient Cohort (2009-2024)" is a detailed good study
in which authors reviewed a large number of liver biopsies done over a long-time scale. The
authors then analyzed the data and categorized the most prevalent diseases in these biopsies,
their temporal distribution, and pathological manifestations across different age groups.
However, I have few comments on the study.
1-In methodology section the authors mentioned that (1.3.2 Pathological Features included
inflammation grade (AG), fibrosis grade (FG), and steatosis grade (SG), all graded according to
standard pathological scoring systems.) the authors need to specify the used scoring system.
2-Also, in methodology section the authors mentioned (1.34 Treatment Regimens: Divided
into anti-HBV and primary disease-targeted therapy (Regimen a) and liver-protective and
symptomatic treatment (Regimen b), which may incorporate traditional Chinese medicine for
antifibrotic purposes.) They need to mention more details about these treatment regimens which
are mentioned only under figure 10 but not mentioned anywhere in the text.
3-In the result section (2.1 Characteristics of the patients submitted to percutaneous liver
biopsies) the authors mentioned that 50 patients undergoing three or more procedures, and a
case involved a single patient who underwent eight biopsies over a span of 15 years. The authors
need to mention the underlying pathology in those patients and the cause of multiple biopsies in
them especially that about 11 patients exposed to more than 4 biopsies.
4-Also, they need to clarify the cause of marked increase in number of liver biopsies between
2013-2023. I expected it to be more before 2013 and the use of noninvasive methods like fibro-
scan and transient elastography as standard of care.
5-Also, in the result section (2.4 Evaluation of different treatment effects of chronic hepatitis B
through multiple liver punctures) the authors need to clarify if the 50 patients who underwent
multiple biopsies were all chronic hepatitis B patients or not. If not, they need to do subgroup
analysis for those patients regarding different diagnoses and treatment regimen for better
evaluation of response of different regimens and different diseases. The authors mentioned that a
substantial group of HBV patient experienced slow disease progression regarding inflammation
and fibrosis despite antiviral therapy. They need to clarify if they had isolated HBV or
combined HBV and MASLD for example. They also mentioned that a substantial number of
patients adhering to Treatment with long-term liver protection and symptomatic management
demonstrated stabilization of both inflammation and fibrosis levels during extended follow-up.
They need also to clarify the pathological diagnosis of these patients.
6-In discussion section the authors mentioned (CHB-MASLD co infection) MASLD is not
infection they can call it coexistence.
7-moreover, in discussion section the authors mentioned adequate bed rest as a line of therapy for
patients with CHB-MASLD comorbidities. MASLD patients usually have sedentary lifestyle,
and we should encourage them to exercise and increase physical activity.
8-In table 1 regarding age the authors mentioned that it ranged from 7-85. they included pediatric
population below 18 in the study. So, it is better to do subgroup analysis for pediatric population
as hepatic disease distribution is totally different between adults and children.
9-The paper needs some language check.