Dear Doctor,

I have chronic Hep B. Liver Biopsy showed that I have Fibrosis stage2, Inflammation Grade1. The doctor said that they inspected two slides. The first slide showed fibrosis stage1 and the second slide showed fibrosis stage2. The doctor also said that the sample size was good.

Is there a possibility that the sample taken for my liver biopsy was from relatively good part of my liver? I am concerned about the variation in such a small sample size. How accurate is the liver biopsy?

I really appreciate your valuable feedback.

When evaluating a liver biopsy there are a few things to keep in mind: 1. It is important for the pathologist to see if your biopsy sample was "adequate". Adequacy is determined by the number of "portal tracts" that are seen. It sounds from your description that your doctor was happy with the size of the sample. 2. There was some variation between the two readings; however stage 1 and stage 2 are at least in the same territory of disease. I would be much more concerned if you told me the results were highly discordant (ie stage 1 and stage 4). 3. Although we say the liver biopsy is the gold standard, it is clear from studies that this procedure is still limited in some ways for the reason you state - the sample is still quite small relative to the size of the organ. So there can be sampling error. 4. However, there is no good substitute right now, particularly for hepatitis B infection where other non-invasive markers have not been studied well.

Dr. McGovern