Assessment of fibrosis and cirrhosis in liver biopsies: an update

The liver biopsy specimen represents valuable material for the assessment of fibrosis and cirrhosis. Despite limitations related to sampling and interpretation, histologic examination remains the gold standard for staging chronic liver diseases. Hepatic fibrosis is currently viewed as a dynamic process that may often regress after successful treatment of chronic liver diseases. Even the excess fibrous tissue of cirrhotic livers may sometimes regress over time. Distinguishing between the amount of hepatic fibrosis and the disease stage is important for the assessment of the effects of antifibrotic treatments. Recent studies suggest that the proportion of the liver biopsy specimen occupied by collagen is correlated with the hepatic venous pressure gradient in liver transplant recipients with hepatitis C virus infection, with or without cirrhosis, and represents a predictor of clinical decompensation. This parameter has also been found to correlate with liver stiffness measurements of patients with chronic viral hepatitis obtained by transient elastography. Therefore, quantitative assessment of hepatic fibrosis in liver biopsy specimens holds promise as a prognostic marker, and as a means to validate noninvasive markers of fibrosis.