Histological assessment of the liver

Histopathological assessments play an important role in the diagnosis and management of patients with liver disease. For some conditions, liver biopsy is still used routinely to establish or confirm the cause of liver disease. In other circumstances, evaluation of morphological changes provides additional information that is useful for clinical management - for example, when assessing disease severity in chronic viral hepatitis and non-alcoholic fatty liver disease. However, with the increased use of non-invasive methods for assessing the severity of liver injury, particularly fibrosis, the role of liver biopsy in this respect is changing. In cases where a dual pathology is suspected, histological assessment may help to identify the main cause of liver injury. In addition, liver biopsy sometimes reveals abnormalities (e.g. iron overload, α1-antitrypsin globules) that have not been detected by previous investigations. Histopathological assessment of liver biopsies involves a systematic evaluation of changes involving individual components of the normal liver. The final interpretation of the abnormalities detected depends on clinicopathological correlation. Sampling variation is a problem, particularly with small needle biopsies, and should be considered as a possible explanation when there is a disparity between clinical and pathological findings. Conventional histological assessments can be supplemented by scoring of individual features such as inflammatory grade and fibrosis stage; histological scoring is most appropriate in the context of large clinical trials.