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Fibrosis in the liver role of histology – is it the gold standard? BSG Annual meeting post- graduate course 20 March 2006. Amar Paul Dhillon Royal Free & University College Medical School. Fibrosis in the liver role of histology– is it the gold standard? Outline. Introduction.
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Amar Paul Dhillon
Royal Free & University College Medical School
1970Encycl. Brit. X. 547/2 Gold standard, a monetary system in which the standard unit is a fixed weight of gold or is kept at the value of a fixed weight of gold.
Claassen J. BMJ 330, 1121; 2005. The gold standard: not a golden standard.
The answer is not difficult, but the question is tricky.
Fig. 5. Percentage of correctly classified biopsies with the converted
METAVIR score of fibrosis according to length of biopsy specimen.
(A) Value for different stages
52 consecutive patients with HCV, paired liver biopsies.
Separate, synchronous (18G needle) samples of R and L lobes of liver.
Sample mean length R lobe = 2.8+/-1.1cm; L lobe = 2.5+/-0.9 cm.
(samples <15mm in 2 patients who were excluded from the analysis)
Ishak scoring system: no significant difference in stage or grade
between R and L lobe samples.
Differences between morphological appearance, description,
stage scoring and liver fibrosis measurement
From: Standish R et al.
An appraisal of the histopathological assessment of liver fibrosis.
Gut in press.
What do we mean by “liver fibrosis”? Histological fibrosis/stage scores of liver are a mixture of descriptions of fibrotic and architectural histopathological changesKnodell RG et al. Hepatology 1,431;1981Ishak KG et al. J Hepatol 22,696;1995
is required for the reliable measurement of
(chronic hepatitis) disease related liver fibrosis
Hoofring A et al. J Hepatol 39, 738–741; 2003.
Three-dimensional reconstruction of hepatic bridging fibrosis
in chronic hepatitis C viral infection.
The affected portal tracts are up to 0.4 mm diameter.
From: Standish R et al. An appraisal of the histopathological assessment of liver fibrosis.Gut in press.