Liver biopsy in the diagnosis of cirrhosis.
Authors: P J Scheuer
Journal: Gut (1970)

Progress reportLiver biopsy in the diagnosis of cirrhosis Many diagnostic procedures are now available for the assessment of the cirrhotic patient; for example, measurement of serum antibodies against smooth muscle and mitochondria helps in the recognition of active chronic hepatitis and primary biliary cirrhosis, and an important complication of cirrhosis, primary liver cell carcinoma, is more readily diagnosed with the aid of coeliac axis arteriography, liver scintiscanning, and estimation of a-fetoglobin in the patient's serum.In spite of the use of such modern methods, liver biopsy continues to play a part in the diagnosis and management of cirrhotic patients, and concepts of the disease remain firmly based on morphology.This article is an attempt to summarize the different uses of percutaneous biopsies in cirrhotic patients and to review the problems of interpretation caused by the provision of a sample representing perhaps one hundred thousandth of the whole organ.There is much disagreement on the value of percutaneous, blind needle biopsies in establishing a diagnosis of cirrhosis.Braunstein' took multiple needle samples from cirrhotic livers at necropsy, using a Vim-Silverman needle.Of 507 samples only 10 failed to reveal cirrhosis.The accuracy of diagnosis in posthepatitic and postnecrotic cirrhosis was 96%, that in 'nutritional' cirrhosis 100%.The author concluded that if a biopsy failed to show fibrosis or cirrhosis, a diagnosis of cirrhosis could be ruled out with reasonable certainty.This view is supported by Baggenstoss2 who found liver biopsy a good method of establishing a morphological diagnosis of cirrhosis, though less helpful in determining its cause.Wilber and Faulk3 stated that a morphological diagnosis of cirrhosis was rarely in error, but that this was of relatively little help to the clinician.On the other hand Vido and Wildhirt,4 expressing a view prevalent on the continent of Europe, prefer laparoscopy as a method of diagnosing cirrhosis.In their series of 272 patients with cirrhosis blind biopsy failed to establish the diagnosis in just over half, and these authors regard liver biopsy as more useful in following the progress of the lesion than in establishing its presence.These differences are partly explained by the fact that the widely used Menghini needle tends to glance off the hard fibrous tissue and selectively samples the softer parenchyma, a problem largely avoided by the cutting action of the Vim- Silverman needle.There has been an attempt to overcome this problem by the use of newer needles having some of the advantages of both.5 What- ever the type of needle used, accurate diagnosis of cirrhosis in biopsies depends on an understanding of the morphological changes, and on the differentiation of cirrhosis from fibrosis; in any liver with extensive fibrosis a few peninsulas of parenchyma will be seen as islands in cross section, and may lead to a wrong diagnosis of hyperplastic nodules and hence cirrhosis.In the majority of cases of cirrhosis, in most parts of the world, aetiology cannot be determined from the histological appearances.In others, features of alcoholic liver disease, biliary obstruction, venous outflow obstruction, or haemochromatosis can be recognized with reasonable certainty.Areas of intense activity showing liver cell destruction, rosette formation, and plasma cell infiltration suggest that the cirrhosis may be the end result of active chronic hepatitis, but this is itself of unknown aetiology.In active chronic on July 15,