Interpreting Disease Progression in Chronic Liver Disease
Interpreting Disease Progression in Chronic Liver Disease
The proposal to abolish the term 'cirrhosis' as a synonym of morphological end stage is an important initial step towards a change in the clinical and pathophysiological interpretation of advanced chronic liver disease. Among other relevant inputs, the authors of this proposal suggest to replace the semiquantitative scoring systems with a standardised morphometric analysis of liver tissue fibrosis. Indeed, computer-assisted morphometry could provide a quantitative measure of hepatic fibrosis on a continuous scale and, when adequately standardised, greatly reduce intraobserver and interobserver variability. Morphometric analysis using the CPA system has demonstrated an excellent positive correlation between the amount of fibrosis in a cirrhotic liver and the relative hepatic vein pressure gradient (HVPG) and liver tissue stiffness. In chronic HCV infection, fibrosis progression was shown to occur at a variable pace with non-linear changes that could only be detected by morphometry. More recently, morphometry has been proposed for the characterisation of the histopathological features of potential disease regression in patients with HCV cirrhosis achieving a SVR following antiviral treatment. Interestingly, although fibrosis and even cirrhosis seem to regress significantly in SVR patients, other aspects closely related to the fibrogenic process, such as ductular proliferation, loss of lobular zonation, portal inflammation and sinusoidal capillarisation may not regress after viral eradication. This observation, while further highlighting the higher discriminative potential of morphometry, suggests that a more comprehensive analysis, that is, not limited to the assessment tissue fibrosis, is needed for the characterisation of disease progression and regression.
Taken together, these considerations promote a thoughtful re-evaluation of the role of liver biopsy in modern hepatology. Indeed, in times when non-invasive methodologies for assessing liver fibrosis have become more and more established and diffuse in clinical practice, the role of the liver biopsy is thoroughly reconsidered for a more comprehensive disease evaluation particularly in the more advanced stages.
Beyond Semiquantitative Scoring: The Morphometric Approach for the Quantisation of Liver Tissue Fibrosis
The proposal to abolish the term 'cirrhosis' as a synonym of morphological end stage is an important initial step towards a change in the clinical and pathophysiological interpretation of advanced chronic liver disease. Among other relevant inputs, the authors of this proposal suggest to replace the semiquantitative scoring systems with a standardised morphometric analysis of liver tissue fibrosis. Indeed, computer-assisted morphometry could provide a quantitative measure of hepatic fibrosis on a continuous scale and, when adequately standardised, greatly reduce intraobserver and interobserver variability. Morphometric analysis using the CPA system has demonstrated an excellent positive correlation between the amount of fibrosis in a cirrhotic liver and the relative hepatic vein pressure gradient (HVPG) and liver tissue stiffness. In chronic HCV infection, fibrosis progression was shown to occur at a variable pace with non-linear changes that could only be detected by morphometry. More recently, morphometry has been proposed for the characterisation of the histopathological features of potential disease regression in patients with HCV cirrhosis achieving a SVR following antiviral treatment. Interestingly, although fibrosis and even cirrhosis seem to regress significantly in SVR patients, other aspects closely related to the fibrogenic process, such as ductular proliferation, loss of lobular zonation, portal inflammation and sinusoidal capillarisation may not regress after viral eradication. This observation, while further highlighting the higher discriminative potential of morphometry, suggests that a more comprehensive analysis, that is, not limited to the assessment tissue fibrosis, is needed for the characterisation of disease progression and regression.
Taken together, these considerations promote a thoughtful re-evaluation of the role of liver biopsy in modern hepatology. Indeed, in times when non-invasive methodologies for assessing liver fibrosis have become more and more established and diffuse in clinical practice, the role of the liver biopsy is thoroughly reconsidered for a more comprehensive disease evaluation particularly in the more advanced stages.
Source...