title: New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment.
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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Yameng
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Jialing
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
authors.forename: Yongpeng
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Infectious Department, Affiliated Hospital of Yanbian University, Yanji, China.
authors.forename: Hongxin
authors.initials: H
authors.lastname: Piao
authors.affiliation: Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lungen
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Youqing
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Hepatology Institute, Peking University People's Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.affiliation: Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Yuemin
authors.initials: Y
authors.lastname: Nan
authors.affiliation: Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Xie
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing, China.
authors.forename: Guofeng
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Infectious Disease, the Fifth Hospital of Shijiazhuang City, Shijiazhuang, China.
authors.forename: Huanwei
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People's Armed Police Force, Tianjin, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
authors.forename: Huiguo
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
authors.forename: Fudong
authors.initials: F
authors.lastname: Lv
authors.affiliation: Department of Pathology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Shao
authors.affiliation: Department of Pathology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Tailing
authors.initials: T
authors.lastname: Wang
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Ou
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Bingqiong
authors.initials: B
authors.lastname: Wang
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore.
authors.forename: Aileen
authors.initials: A
authors.lastname: Wee
authors.affiliation: Departments of Pathology and Medicine (Division of Digestive Diseases), Mount Sinai Beth Israel Medical Center, New York, NY.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Theise
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: You
authors.affiliation: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
authors.forename: Jidong
authors.initials: J
authors.lastname: Jia
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D005355:Fibrosis; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged
chemical_list: D000998:Antiviral Agents; C413685:entecavir; D006147:Guanine