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Interpretation of liver biopsy specimens

Maria Isabel Fiel, MD, FAASLD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Kristen M Robson, MD, MBA, FACG


The histopathologic examination of the liver can provide otherwise unobtainable information regarding its structural integrity and the type and degree of injury and/or fibrosis that affect the liver [1-3]. It is also useful for monitoring the efficacy of treatment and permits the definitive diagnosis of tumors.

A liver biopsy is usually performed after a thorough, noninvasive clinical evaluation in patients with chronically (greater than six months) elevated liver biochemical tests. The pertinent clinical information should be made available to the pathologist so that the histopathological findings can be interpreted in the appropriate clinical context [1-3]. (See "Approach to the patient with abnormal liver biochemical and function tests".)

This topic review will focus on the interpretation of liver biopsy specimens. The examples presented show typical histologic features of each disease entity. Methods to obtain a liver biopsy and histologic scoring systems for chronic liver disease are described elsewhere. (See "Approach to liver biopsy" and "Transjugular liver biopsy" and "Histologic scoring systems for chronic liver disease".)


The liver can be divided into right and left lobes, each of which has its own blood supply. The right lobe comprises 50 to 70 percent of the liver mass (figure 1). The liver can be further subdivided into eight segments based upon the segmental hepatic arterial supply and distribution.


Two conceptual models have been proposed relating to the architecture of the hepatic parenchyma. Terminal portal veins and hepatic venules interdigitate between sinusoids. The "lobule" model considers the terminal hepatic venules, which are also known as the central vein/venules, to be the center of the hepatic microcirculation. Thus, this area is known as the centrilobular zone, whereas in the "acinar" model (also known as the Rappaport classification) is considered to represent the periphery of the acinus (figure 2).

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Literature review current through: Nov 2017. | This topic last updated: Sep 13, 2016.
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