Liver biopsy in primary biliary cholangitis: is sinusoidal fibrosis the missing key?

AIMS

The role of liver biopsy in primary biliary cholangitis (PBC) is controversial, as is the optimal method of histological assessment. We compared the Ludwig and Ishak systems and three components of the Japanese (Nakanuma) staging system to evaluate their clinical and biochemical correlations and prognostic value.

METHODS

We reviewed biopsies from 106 patients with PBC, derived from a previous trial of colchicine therapy with 24-34 years' follow-up, following which five clinical outcomes were evaluated: hepatic decompensation, cholestatic PBC death/liver transplant, portal hypertensive PBC death, all PBC deaths and overall survival.

RESULTS

Ludwig and Ishak stages correlated well with prognostically significant parameters, including serum bilirubin, and both Mayo and Child Scores. Serum aspartate aminotransferase correlated with interface hepatitis (IFH), and alkaline phosphatase with orcein deposition, bile duct (BD) loss and cholestasis. Ludwig correlated with all five clinical outcomes, while Ishak stage was only significantly correlated with two. While sinusoidal fibrosis, orcein deposition, BD loss and cholestasis all predicted hepatic death/transplant, after correction for Mayo Score, the only histological parameters predictive of clinical outcomes were IFH (associated with two) and sinusoidal fibrosis (associated with all five).

CONCLUSION

Liver biopsy is required in the diagnosis of around 20% of patients with PBC. The Ludwig system is of more prognostic value than both Ishak and any of the three individual components of the Nakanuma staging system, but the major histological parameter providing independent prognostic value beyond the Mayo Score is sinusoidal fibrosis.

Assessment and correlation between functional and histological staging of oral submucous fibrosis: A clinicohistopathologic study

Background and Objective

Oral submucous fibrosis (OSMF) is a precancerous condition. It is widespread in the Asian subcontinent, with India bearing most of the burden. It is characterized by mucosal rigidity of varying intensity due to the fibroelastic changes of the juxta epithelial layer, resulting in a progressive inability to open the mouth. Early recognition with accurate staging of the disease and appropriate treatment planning is of utmost importance to prevent the malignant transformation and to improve the quality of life of the patient. In the present study, an attempt is made to clinically evaluate the condition and correlate it with the histopathological findings according to standard criteria.

Materials and Methods

A hospital-based study was conducted on sixty OSMF patients. Detailed history was recorded, and functional staging was given depending on mouth opening. Punch biopsy was performed, and histological stages were given based on standard criteria. The data so received were mathematically evaluated to determine whether any correlation exists between the stages using Chi-square test.

Results

The sixty patients were in the age range of 16-50 years. Male-to-female ratio was that of 97:3. The statistical analysis using Chi-square test showed statistically significant association (P < 0.001) between the functional and histologic stages.

Conclusion

There is a definite correlation between functional and histological stages of OSMF which suggests that clinically advanced OSMF has extensive fibrosis histologically.