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One of the most important aspects of the histopathological assessment of liver biopsies in the setting of chronic liver disease is determination of the degree of fibrosis and architectural change. Most of the work in this regard has been concerned with chronic viral hepatitis. This article attempts to assess critically our current and historical biopsy practice, from subjective fibrosis scoring systems to biopsy sample size; and the appropriate use of the data that scoring systems generate in the research and clinical setting. An understanding of the limitations of each of the components of the fibrosis assessment process can help to devise appropriate protocols to ensure that the information obtained is optimised, and its degree of reliability appreciated. It is only from this starting point that recently promulgated antifibrotic medications and “non-invasive” liver fibrosis assessment techniques can be evaluated properly.
The degree of liver fibrosis is one of the most important diagnostic and prognostic assessments in chronic liver disease. Histological assessment of fibrosis is regarded as the “gold standard” in this respect. Clinical manifestations of liver disease and liver dysfunction accompany architectural changes of the liver parenchyma that are a result of advanced stages of liver fibrosis. Previously, it was thought that liver fibrosis and end stage liver disease (cirrhosis) were irreversible, and therefore crude determinations of liver fibrosis were acceptable because the therapeutic impact of this assessment was relatively minor. Recent work suggests that liver fibrosis may be modified by treatment1–4 and so critical re-evaluation of the histopathological methods used to assess liver fibrosis is necessary. Liver biopsy assessment of fibrosis is not only the end point for the development of antifibrotic treatments but also forms the benchmark for validation of serum “surrogate markers” of liver fibrosis and other non-invasive techniques that purport to measure liver fibrosis and …
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