New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment. Issue 5 (22nd March 2017)

• Record Type: Journal Article
• Authors: Sun, Yameng; Zhou, Jialing; Wang, Lin; Wu, Xiaoning; Chen, Yongpeng; Piao, Hongxin; Lu, Lungen; Jiang, Wei; Xu, Youqing; Feng, Bo; Nan, Yuemin; Xie, Wen; Chen, Guofeng; Zheng, Huanwei; Li, Hai; Ding, Huiguo; Liu, Hui; Lv, Fudong; Shao, Chen; Wang, Tailing; Ou, Xiaojuan; Wang, Bingqiong; Chen, Shuyan; Wee, Aileen; Theise, Neil D.; You, Hong; Jia, Jidong
• Is Part Of: Hepatology. Volume 65:Issue 5(2017)
• Page Start: 1438
• Page End: 1450
• Publication Date: 2017-03-22
• Subjects: Heart -- Diseases -- Nursing -- Periodicals; Lungs -- Diseases -- Nursing -- Periodicals; Intensive care nursing -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1002/hep.29009
• Languages: English
• ISSNs: 0270-9139

Abstract

Abstract : Liver fibrosis is the net result of dynamic changes between fibrogenesis and fibrolysis. Evidence has shown that antiviral therapy can reverse liver fibrosis or even early cirrhosis caused by hepatitis B virus. However, current evaluation systems mainly focus on the severity of, but not the dynamic changes in, fibrosis. Here, we propose a new classification to evaluate the dynamic changes in the quality of fibrosis, namely: predominantly progressive (thick/broad/loose/pale septa with inflammation); predominately regressive (delicate/thin/dense/splitting septa); and indeterminate, which displayed an overall balance between progressive and regressive scarring. Then, we used this classification to evaluate 71 paired liver biopsies of chronic hepatitis B patients before and after entecavir‐based therapy for 78 weeks. Progressive, indeterminate, and regressive were observed in 58%, 29%, and 13% of patients before treatment versus in 11%, 11%, and 78% after treatment. Of the 55 patients who showed predominantly regressive changes on posttreatment liver biopsy, 29 cases (53%) had fibrosis improvement of at least one Ishak stage, and, more interestingly, 25 cases (45%) had significant improvement in terms of Laennec substage, collagen percentage area, and liver stiffness despite remaining in the same Ishak stage. Conclusion : This new classification highlights the importance of assessing and identifying the dynamic changes in the quality of fibrosis, especially relevant in the era of antiviral therapy.(Hepatology 2017;65:1438‐1450)