Article

Fibrosis distribution in explanted cirrhotic livers.

The Department of Cellular Pathology, UCL Medical School, Royal Free Campus, London, UK.
Histopathology (impact factor: 3.08). 01/2012; 60(2):270-7. DOI:10.1111/j.1365-2559.2011.04094.x pp.270-7
Source: PubMed

ABSTRACT Little information is available regarding the distribution of fibrosis within cirrhotic livers. We measured collagen in cirrhotic explants to determine if fibrosis differs (i) between left (L) and right (R) lobes, and (ii) between different aetiologies.
Ten cases each of common aetiologies of cirrhosis were studied: alcoholic liver disease (ALD), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), hepatitis C virus (HCV) and hepatitis B virus (HBV). A total of 120 tissue blocks (one block each from L and R lobes) were studied. Collagen was measured as collagen proportionate area (CPA), i.e. the proportion of the tissue sections stained by picro-Sirius red. L and R lobes contained similar amounts of fibrosis (r = 0.788; P < 0.0001) with good agreement between L and R lobes (Bland-Altman analysis, R lobe bias = 1.35%). Median CPA across all aetiologies (R plus L lobes) was 21.5%, (L = 8-40%, R = 10-47%). There was more fibrosis in ALD (30%, 15-47%) than PBC (23.5%, 16-34%) and PSC (22.5%, 8-33%), which in turn showed more than AIH (18.5%, 10-40%), HCV (17%, 13-31%) and HBV (16.5%, 8-30%).
At the time of transplantation cirrhotic livers have different ranges of collagen proportionate area, according to aetiology. R lobe fibrosis corresponds with L lobe fibrosis. The range of fibrosis within each aetiological group could be useful for prognostic subclassification.

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    Article: Sample size requirement for digital image analysis of collagen proportionate area in cirrhotic livers.
    Andrew Rennie Hall, Emmanuel Tsochatzis, Richard Morris, Andrew Kenneth Burroughs, Amar Paul Dhillon
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    ABSTRACT: Hall A R, Tsochatzis E, Morris R, Burroughs A K & Dhillon A P (2012) Histopathology Sample size requirement for digital image analysis of collagen proportionate area in cirrhotic livers Aims:   The requirements for adequate cirrhotic liver biopsy size have not been established for quantitative fibrosis measurements (collagen proportionate area: CPA). We evaluated the CPA of virtual biopsies in cirrhosis to elucidate (i) the amount of tissue required to achieve reliable CPA measurements and (ii) the effect of aetiology on sample size requirements. Method and results:   A total of 120 cirrhotic tissue blocks (six aetiologies) were studied. A representative 100 mm(2) region was selected from each block and a reference CPA measured. Each image (n = 120) was divided into 100 × 1 mm(2) images; CPA was measured for each 1 mm(2) and virtual biopsies of different sizes were created from the 1 mm(2) components. For each virtual biopsy size the probability that the virtual biopsy CPA would be within 5% of the reference CPA was calculated. There were 441 000 virtual biopsies. Biopsy size versus probability plots indicated that, for 90% probability that the virtual biopsy CPA can be expected to be within 5% of the reference CPA, 22-28 mm(2) of analysable tissue is required depending on liver disease aetiology; and that a 75% probability level requires a biopsy with 12-15 mm(2) of analysable tissue. Conclusion:   The sample size required for a given probability level depends on the aetiology of cirrhosis, and this should be taken into account when judging the reliability of cirrhotic liver biopsy CPA.
    Histopathology 11/2012; · 3.08 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

120 tissue blocks
 
aetiological group
 
alcoholic liver disease
 
autoimmune hepatitis
 
cirrhotic explants
 
cirrhotic livers
 
collagen proportionate area
 
common aetiologies
 
different aetiologies
 
hepatitis B virus
 
hepatitis C virus
 
L lobe fibrosis
 
L lobes
 
PBC
 
primary biliary cirrhosis
 
primary sclerosing cholangitis
 
R lobe bias
 
R lobe fibrosis
 
tissue sections stained
 
transplantation cirrhotic livers