Decoding liver biopsies: a pattern-based approach

The histological evaluation of liver biopsies is a crucial component in the diagnosis and management of a wide range of liver diseases. This process, often complex and detailed, requires a systematic, stepwise approach. Initially, pathologists must identify the overall injury pattern at low magnification, providing a foundation for further investigation. Once the injury pattern is recognized, it is essential to carefully examine the biopsy for distinctive microscopic features that may provide additional diagnostic clues. Many hepatic injury patterns are linked to well-established differential diagnoses, which help guide the diagnostic process. The assessment of a liver biopsy extends beyond simply identifying injury patterns. It requires a thoughtful integration of pathological findings, differential diagnoses, the patient's clinical presentation, as well as relevant laboratory tests and imaging studies. This comprehensive approach is essential, as it offers invaluable insights into the underlying etiology of the liver disease. In this review, we will focus on the most commonly encountered hepatic injury patterns. By enhancing the diagnostic accuracy and ensuring a thorough interpretation of liver biopsies, pathologists can significantly contribute to the effective management and treatment of liver disorders.