A survey of liver pathology in needle biopsies from HBsAg and anti-HBe positive individuals

Aims-To use laboratory data and liver biopsies, prospectively obtained from hepatitis B surface antigen (HBsAg) and anti hepatitis B e antigen (anti-H Be) positive patients, for the assessment of: (1) the relation between biop sy length/number of portal tracts and sampling error; (2) the relation betw een the severity of piecemeal necrosis and the new grading terminology (min imal, mild, moderate, and severe chronic hepatitis); and (3) liver patholog y, which has not been studied in patients with this specific serological pr ofile. Methods-The study group (n = 174) included 104 patients with normal aminotr ansferase concentrations and no cases with clinically apparent cirrhosis. T he specimen length and number of portal tracts were measured art light micr oscopy examination. Sampling error analysis was related to the discrepancie s between aminotransferase concentrations versus histological grade. Detail ed histological scorings were undertaken by the reference pathologist and c ompared with laboratory and hepatitis B virus (HBV) DNA precore sequence da ta. Results-Sampling error seemed to be a constant feature, even for biopsies g reater than or equal to 20 mm, but increased dramatically in biopsies < 5 m m long and/or containing less than four portal tracts. Between 25% and 30% of biopsies, graded as "mild" or "moderate" activity showed features of mod erate and severe piecemeal necrosis, respectively. Ten per cent of the pati ents with normal aminotransferase values had stage III-IV hepatic fibrosis, and 20% had piecemeal necrosis. Only cytoplasmic, not nuclear, core antige n expression was a strong predictor of high hepatitis B viraemia. There was no association between precore stop codon mutations, grade/stage of liver disease, and hepatitis B core antigen (HBcAg) expression. Conclusions-The specimen available for light microscopical examination shou ld be > 5 mm long and should contain more than four portal tracts. In addit ion, the new grading terminology might give the clinician an inappropriatel y mild impression of the severity of piecemeal necrosis. Furthermore, even in the presence of normal aminotransferase concentrations, considerable liv er pathology can be found in 10-20% of HBsAg and anti-HBe positive individu als; such pathology is not associated with the occurrence of precore stop c odon mutations.