From the Guidelines
A good quality liver biopsy is characterized by a specimen length of at least 15 mm and the presence of a sufficient number of portal tracts, with a non-fragmented specimen and adequate width being desirable for accurate fibrosis staging. When evaluating the quality of a liver biopsy, two key factors are crucial: the length of the specimen and the presence of a sufficient number of portal tracts. According to the most recent guidelines 1, a non-fragmented specimen with a length of at least 15 mm is usually considered adequate. Additionally, the presence of at least 11 portal tracts is recommended, as defined by Munsterman et al.
Some key points to consider when evaluating the quality of a liver biopsy include:
- The length of the specimen, with a minimum of 15 mm being recommended 1
- The presence of a sufficient number of portal tracts, with at least 11 being desirable 1
- The width of the liver biopsy, which should be considered to avoid underestimation of fibrosis staging 1
- The use of different staining methods, such as Masson trichrome and picrosirius red, to assess liver fibrosis 1
- The evaluation of the quality and texture of fibrosis, which reflects the chronicity of liver injury and its potential reversibility 1
It is also essential to highlight that the pathologist's expertise is crucial when interpreting liver biopsies, and dedicated pathologists should interpret biopsies in referral centers 1. Proper handling of the specimen, including immediate fixation in formalin, is also necessary to preserve tissue architecture and prevent degradation that could compromise diagnostic accuracy.
From the Research
Characteristics of a Good Quality Liver Biopsy
Two key characteristics that indicate a good quality liver biopsy are:
- Length: A biopsy specimen that is 20 to 25 mm long 2 or at least 15 mm long 3 is considered to be of good quality.
- Number of portal tracts: A specimen that contains more than 11 complete portal tracts (CPTs) 2 is considered to be of good quality, with studies showing that cases with 11 or more portal tracts are associated with more accurate staging of chronic hepatitis 3.
Additional Factors
Other factors that can influence the quality of a liver biopsy include:
- Specimen size: A larger specimen size is generally associated with a higher number of portal tracts and a more accurate diagnosis 3, 4.
- Biopsy technique: The use of ultrasound guidance and a subcostal route can improve the safety and efficacy of percutaneous liver biopsy 5.
- Patient preparation: The use of sedation, such as midazolam, can improve patient comfort and acceptance of the procedure 6.