The relationship between liver disease stage and liver fibrosis: a tangled web

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The relationship between liver disease stage and liver fibrosis: a tangled web

Authors: Germani, Giacomo1; Burroughs, K1; Dhillon, Amar P2

Source: Histopathology, Volume 57, Number 6, December 2010 , pp. 773-784(12)

Publisher: Wiley-Blackwell

Abstract:

Germani G, Burroughs A K & Dhillon A P

(2010) Histopathology57, 773-784

The relationship between liver disease stage and liver fibrosis: a tangled web

The structural consequences of chronic liver disease are described as a series

of liver disease `stages' with scarring and architectural change that eventually

destroys and replaces the normal lobular structure of the liver. Fibrosis

(`excess collagen') and stage have been confused in histological staging

systems. Fibrosis is part of increasing liver disease stage, but fibrosis and

stage are different. Staging liver disease is important in routine

histopathological assessment. Measurement of liver fibrosis is another process.

The collagenous proportion of a liver biopsy [collagen proportionate area (CPA)]

correlates with hepatic venous pressure gradient (HVPG), which is of recognized

prognostic value. CPA at 1 year post-transplantation in hepatitis C

virus-infected patients predicts subsequent clinical decompensation. CPA in

cirrhotic patients predicts decompensation more accurately than staging or HVPG.

The `cirrhosis' stage category has poor prognostic power, and CPA effectively

substages cirrhosis. CPA improves the description of liver disease stage. Proper

validation of antifibrotic treatments and `non-invasive markers of liver

fibrosis' requires measurement of liver fibrosis (and not liver biopsy stage

scores). It is unacceptable for the words `fibrosis' and `score' to remain next

to each other. There are benefits to properly understanding liver fibrosis and

liver disease stage and properly assessing each of them.

Document Type: Research article

DOI: 10.1111/j.1365-2559.2010.03609.x

Affiliations: 1: The Royal Free Sheila Sherlock Liver Centre and University

Department of Surgery UCL, Royal Free Hospital 2: Department of Cellular

Pathology, UCL Medical School, Royal Free Campus, London, UK

Publication date: 2010-12-01