The liver biopsy is essential to the investigation and management of chronic liver disease. The pathologist provides an etiologic diagnosis, reports the grade of disease activity and stage of fibrosis, and comments on any response to therapy. Recent progress in our understanding of chronic hepatitis, its causes, prognosis, and therapy, has influenced the revision of its nomenclature and classification. The use of a descriptive or numerical scoring system allows the pathologist to provide reproducible, clinically relevant information in the surgical pathology report.
De GrooteJ, DesmetV, GedigkP, A classification of chronic hepatitis. Lancet1968;2:626–628.
2.
BoyerJL, KlatskinG.Pattern of necrosis in acute viral hepatitis. Prognostic value of bridging (subacute hepatic necrosis). N Engl J Med1970;283:1063–1071.
3.
KnodellRG, IshakKG, BlackWC, Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology1981;1:431–435.
4.
ScheuerPJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol1991;13:372–374.
5.
IshakK, BaptistaA, BianchiL, Histological grading and staging of chronic hepatitis. J Hepatol1995;22:696–699.
6.
ter BorgF, ten KateFJ, CuypersHT, A survey of liver pathology in needle biopsies from HBsAg and anti-HBe positive individuals. J Clin Pathol2000;53:541–548.
7.
BattsKP, LudwigJ.Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol1995;19:1409–1417.
8.
JohnsonPJ, McFarlaneIG. Meeting report: International Autoimmune Hepatitis Group. Hepatology1993;18:998–1005.
9.
IshakKG. Chronic hepatitis: morphology and nomenclature. Mod Pathol1994;7:690–713.
10.
HuangSN, ChenTC, TsaiSL, LiawYF. Histopathology and pathobiology of hepatotropic virus–induced liver injury. J Gastroenterol Hepatol1997;12:S195–S217.
11.
IshakKG. Pathologic features of chronic hepatitis. A review and update. Am J Clin Pathol2000;113:40–55.
12.
BianchiL, GudatF.Chronic hepatitis. In: MacSweenP, AnthonyP, ScheuerP, PortmannB, BurtA, eds. Pathology of the Liver, 3rd ed. Edinburgh: Churchill Livingstone, 1994:349–395.
KerrJF, CooksleyWG, SearleJ, The nature of piecemeal necrosis in chronic active hepatitis. Lancet1979;2:827–828.
15.
SobeskyR, MathurinP, CharlotteF, Modeling the impact of interferon alfa treatment on liver fibrosis progression in chronic hepatitis C: a dynamic view. The MULTIVIRC Group. Gastroenterology1999;116:378–386.
16.
DufourJF, DeLellisR, KaplanMM. Reversibility of hepatic fibrosis in autoimmune hepatitis. Ann Intern Med1997;127:981–985.
17.
BedossaP, PoynardT.An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology1996;24:289–293.
18.
GoldinRD, GoldinJG, BurtAD, Intra-observer and inter-observer variation in the histopathological assessment of chronic viral hepatitis. J Hepatol1996;25:649–654.
19.
InuiA, FujisawaT, MiyagawaY, Histologic activity of the liver in children with transfusion-associated chronic hepatitis C. J Hepatol1994;21:748–753.
20.
SuzukiY, KumadaH, IkedaK, Histological changes in liver biopsies after one year of lamivudine treatment in patients with chronic hepatitis B infection. J Hepatol1999;30:743–748.
21.
EversonGT, JensenDM, CraigJR, Efficacy of interferon treatment for patients with chronic hepatitis C: comparison of response in cirrhotics, fibrotics, or nonfibrotics. Hepatology1999;30:271–276.
22.
DienstagJL, SchiffER, WrightTL, Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med1999;341:1256–1263.
23.
de ManRA, MarcellinP, HabalF, A randomized, placebo-controlled study to evaluate the efficacy of 12-month famciclovir treatment in patients with chronic hepatitis Be with antigen-positive hepatitis B. Hepatology2000;32:413–417.
24.
ScheuerPJ. Liver biopsy in chronic hepatitis: 1968–78. Gut1978;19:554–557.
25.
BaggenstossAH, SolowayRD, SummerskillWH, ElvebackLR, SchoenfieldLJ. Chronic active liver disease. The range of histologic lesions, their response to treatment, and evolution. Hum Pathol1972;3:183–198.
26.
DesmetVJ, GerberM, HoofnagleJH, MannsM, ScheuerPJ. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology1994;19:1513–1520.
27.
LokAS, LindsayI, ScheuerPJ, ThomasHC. Clinical and histological features of delta infection in chronic hepatitis B virus carriers. J Clin Pathol1985;38:530–533.
28.
LudwigJ.The nomenclature of chronic active hepatitis: an obituary. Gastroenterology1993;105:274–278.
29.
WestinJ, LaggingLM, WejstalR, NorkransG, DhillonAP. Interobserver study of liver histopathology using the Ishak score in patients with chronic hepatitis C virus infection. Liver1999;19:183–187.
30.
AlloryY, CharlotteF, BenhamouY, OpolonP, Le CharpentierY, PoynardT.Impact of human immunodeficiency virus infection on the histological features of chronic hepatitis C: a case–control study. The MULTIVIRC group. Hum Pathol2000;31:69–74.
31.
ShiratoriY, ImazekiF, MoriyamaM, Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med2000;132:517–524.
32.
HubscherSG. Histological grading and staging in chronic hepatitis: clinical applications and problems. J Hepatol1998;29:1015–1022.
33.
Terminology of chronic hepatitis, hepatic allograft rejection, and nodular lesions of the liver: summary of recommendations developed by an international working party, supported by the World Congresses of Gastroenterology, Los Angeles, 1994. Am J Gastroenterol1994;89:S177–S181.
