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Liver Biopsy Interpretation

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Liver Biopsy Interpretation. PJ Scheuer, JH Lefkowitch (Pp 381; illustrated). London: Harcourt, 2000. ISBN 0 7020 2502 X.

Should general pathologists attempt to interpret liver biopsy specimens at all? I enjoy the great luxury of being able to spend my workday exploring aspects of pancreatic and hepatobiliary pathology almost exclusively, and the more I study the liver the surer I am that doing justice to a liver biopsy specimen is a tough job.

But that job has been made much easier now. The new version (sixth edition) of Scheuer and Lefkowitch's Liver Biopsy Interpretation is a superlative guide for those venturing into liver work. It should be required reading for trainees not only in anatomical pathology but also in hepatology and in surgery of the liver and biliary tree, whom it will assist immeasurably in understanding how the biopsy diagnoses are made that are used to monitor their patients' clinical courses.

The reader is taken by the hand through what to do—and what not to do—in organising all aspects of biopsy management. The authors move from discussions that should precede tissue sampling in unusual or complicated cases through the advantages and disadvantages of processing, sectioning, and staining techniques; they discuss clinicopathological entities, issues in differential diagnosis, and approaches to be taken in clarifying problems, and even give advice on how to structure to its users' best profit the report of findings. The text is buttressed by well selected references that neglect neither classic work nor the most recent advances, with attention to molecular genetics and cellular physiology in our understanding of disease as faced in the clinical and diagnostic laboratory. The figures that the authors provide illustrate their points admirably, and the increased use of colour in this new edition is a delight.

The authors ride their hobby horses now and again, and theirs are not mine (I have never understood why sections stained specifically for elastic tissue, or to point up type I collagen, or with the periodic acid-Schiff technique in the absence of preliminary diastase digestion are so often among those referred for consultative opinion). Nor do I have much use for aspiration cytology of solid, rather than cystic, liver lesions, to which the authors now give half a chapter. If you have a needle in the liver, I say take a true biopsy specimen for a more certain diagnosis.

But, quibbles aside, I know of no better English language liver biopsy handbook than this one. It should be part of the microscope-side library of any pathologist whose practice involves the liver. There it will help him or her not only to do good work but also to meet higher expectations because as consultant internists and surgeons familiarise themselves with this book, the standard of practice of liver histopathology that they demand, as better informed consumers, will necessarily rise.

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