Mistakes in utilising histopathology for the management of liver disease

ABSTRACT

Introduction

Liver biopsy has become selective due to its invasiveness, potential adverse effects, patient acceptance and cost. Furthermore, the emergence of noninvasive tests (NITs) has challenged the necessity of liver biopsies in specific clinical situations. However, liver biopsy continues to play a crucial role in disease diagnosis, prognosis, and evaluating treatment compliance and response in selected patients.

Areas covered

In this narrative review, we discuss the errors and the shortcomings that can occur at various stages, from the initial patient selection for a liver biopsy to the final reporting phase, and strategies to address them. Clinicians and pathologists must take all necessary precautions to mitigate potential shortcomings that could compromise the value of liver biopsies.

Expert opinion

The increasing sophistication of NITs offers a safer, more convenient, and potentially more cost-effective approach to diagnosing chronic liver disease, especially for assessing the degree of liver fibrosis. As NITs continue to evolve, liver biopsy will likely transition to a more targeted role, ensuring optimal patient care in the ever-changing field of hepatology. However, liver biopsy will continue to have a pivotal role in assessing acute liver disease where the diagnostic yield of the liver biopsy still outweighs that of NITs.

KEYWORDS:

• Liver biopsy
• histopathology
• diagnosis
• liver disease
• hepatology

Article highlights

• In current practice, the use of liver biopsy has become more selective due to its invasiveness, potential adverse effects, low patient acceptance and high cost. The emergence of noninvasive biomarkers has challenged the necessity of liver biopsies. Therefore, weighing the risks and benefits before a liver biopsy is essential.

• Many potential mistakes can occur during a liver biopsy, leading to inaccurate results. These mistakes include sampling errors, inadequate sample size, errors in tissue processing, and misinterpretation of the findings.

• It is vital to ensure that an experienced pathologist familiar with the latest trends and advances in liver disease reports the liver histology.

• Liver biopsies should be reported on time so that treatment decisions can be made quickly.

• Given these considerations, clinicians and pathologists must take all necessary precautions to mitigate potential shortcomings that could compromise the value of liver biopsies and ensure that patients receive the best possible care.

• As NITs continue to evolve, liver biopsy will likely transition to a more targeted and specialized role, ensuring safe and optimal patient care.

Abbreviations

ACLD	=	advanced chronic liver disease
CT	=	computer tomography
ELF	=	enhanced liver fibrosis
MRI	=	magnetic resonance imaging
MDT	=	multidisciplinary team
NAFLD	=	nonalcoholic fatty liver disease
NASH	=	nonalcoholic steatohepatitis
NIT	=	noninvasive test
PAS	=	periodic acid-Schiff
US	=	ultrasound

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author’s contributions

MA Niriella conceptualized and outlined the contents of the paper. D Kanagarajah, and JDS Hewavisenthi, collected and analyzed the evidence and drafted the manuscript. MA Niriella, JDS Hewavisenthi, and HJ de Silva were substantially involved in the revision of the manuscript. All authors checked the final manuscript before submission.

Additional information

Funding

This paper was not funded.