**12. Conclusions**

among the five pairs. Five features showed an almost perfect or a substantial degree of concordance among the 10 observers (cirrhosis, fibrosis, fibrosis grading by Knodell in‐ dex, steatosis and portal lymphoid aggregates). The 17 other indicators showed a weak‐ er concordance. Five items had a higher concordance when viewed by a pair of pathologists than when studied by only one pathologist (steatosis, periportal necrosis grading by Knodell index, lobular necrosis grading by Knodell index, centrilobular fibro‐ sis, and ductular proliferation). This study reveals that certain features of major impor‐ tance in assessing disease activity show significant observer variation. The acceptable degree of concordance was related mainly to the fibrosis score, whereas other numerical items displayed substantial observer variations. Simultaneous observation by two pathol‐ ogists increased the reproducibility of numerical scoring and of certain viral hepatitis C lesions. A classification of chronic hepatitis C based on dissociated semiquantitative as‐ sessment of necroinflammatory lesions and fibrosis offers more reproducibility than the

As a single percutaneous liver biopsy yields only a minute percentage (1 ⁄ 50 000 or 0.002%) of the total hepatic tissue, paired biopsies have been evaluated in several published studies, especially for assessing steatosis and NASH. For quantification, better references are re‐ quired, such as imaging techniques or morphometry, which determines the area of steatosis

In fact, as liver steatosis is not homogeneous, classical optical examination of a liver biopsy by a pathologist for measuring liver steatosis by the determination of the percentage of hep‐ atocytes containing lipid vesicles is highly subjective, and steatosis grading corresponds on‐

The role of the liver biopsy in disease management is evolving nowadays and has to be re‐ considered given the modern pathologic assessment of liver biopsy. Pathologists have made progress in the interpretation of liver biopsies and in processing the information in a concise and scientific way available to clinicians. After evaluating the disease state and interpreting the tests results, the clinician in charge of the patient should consider the individual patient

The liver biopsy specimen aims to obtain a valuable material for the assessment of fibrosis and cirrhosis. Despite limitations related to sampling and interpretation, histological exami‐ nation remains the best standard for staging and diagnosing chronic liver diseases. Its indi‐ cations are decreasing because new therapeutical options for chronic viral hepatitis have improved [118]. Moreover, new non-invasive tests have been developed and their use may

All invasive procedures involve risks, consequently the benefits of obtaining liver for histol‐ ogy should always be weighed against the possible morbidity of the procedure. The deci‐ sion to indicate a liver biopsy has to be taken depending on the center's facilities and the

increase in the future, especially for long term management [119] (Table 7).

availability of experienced liver pathologists to interpret the biopsy.

use of a global numerical index [107].

62 Liver Biopsy – Indications, Procedures, Results

ly to a semiquantitative scale [68].

when making recommendations with regards to treatment.

**Role of the liver biopsy in personalized medicine**

on liver biopsy.

What will be the real impact of Liver Biopsy now and in the near future in the era of person‐ alized medicine?


**4.** Therapies, etiology, pathogenesis, cellular and molecular mechanisms, changes in tissue architecture and invasive (HVPG) and noninvasive diagnostic approaches, should be added to the liver biopsy information.

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