Liver biopsy quality criteria to exclude cirrhosis in case of suspicion of porto-sinusoidal vascular disorder - Research article

Q: What is the primary goal of the study regarding liver biopsies in suspected PSVD?

To determine biopsy quality criteria that maximize sensitivity for diagnosing cirrhosis, since ruling out cirrhosis is the first step when PSVD is suspected.

Q: What minimum biopsy length is recommended to exclude cirrhosis in suspected PSVD?

A minimum liver biopsy length of 15 mm, with at least one fragment of 10 mm, is sufficient to exclude cirrhosis.

Q: How do staining method and biopsy route affect sensitivity?

Picrosirius red performs slightly better than Masson’s trichrome for excluding cirrhosis. Percutaneous biopsies show higher sensitivity than transjugular biopsies, although transjugular sampling provides additional pressure-gradient and collateral information.

Sep 29, 2026

Uploaded by Mafia Boss

Liver biopsy quality criteria for ruling out cirrhosis in suspected porto-sinusoidal vascular disorder (PSVD) are evaluated using virtual biopsy assessment derived from liver explants. The study compares percutaneous versus transjugular sampling, multiple biopsy lengths (including fragmented schemes), and fibrosis staining methods. Results show diagnostic sensitivity increases with biopsy length, reaching a plateau at 15 mm, while Picrosirius red slightly outperforms Masson’s trichrome. Fragmented biopsies with at least one 10-mm fragment achieve similar sensitivity. The work proposes minimum criteria to support PSVD diagnosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background & Aims

Methods

Endpoints

Results

Conclusions

Research article Liver biopsy quality criteria to exclude cirrhosis in case of suspicion of porto-sinusoidal vascular disorder Authors Chloé de Broucker, Valérie Paradis, Maria Luisa Botero,…, Paul-Emile Zafar, Juan Carlos Garcia Pagan, Pierre-Emmanuel Rautou Correspondence [pierre-emmanuel.rautou@inserm.fr](pierre-emmanuel.rautou@inserm.fr) (P.-E. Rautou), [valerie.paradis@aphp.fr](valerie.paradis@aphp.fr) (V. Paradis) . Graphical abstract Highlights: • Liver biopsies to rule out cirrhosis in PSVD should be 15 mm long with a 10 mm tissue fragment. • Picrosirius red staining performs slightly better than Masson’s trichrome to exclude cirrhosis. • Percutaneous biopsies better exclude cirrhosis as they are wider than transjugular samples. • Transjugular biopsy provides additional data on hepatic pressure gradient and vein-to-vein collaterals. • Distinguishing incomplete septal cirrrhosis from LaennecA cirrhosis is difficult; repeat biopsy might be needed. Impact and implications: This study shows that, for the diagnosis of porto-sinusoidal vascular disorder, the minimum length of liver biopsy to exclude cirrhosis is 15 mm, with a minimum fragment of 10 mm. Picrosirius red had a slightly better performance than Masson’s trichrome staining. Future guidelines might consider that a 15-mm-long biopsy, with a fragment 10 mm, is sufficient to rule out cirrhosis in case of suspicion of portosinusoidal vascular disorder with signs of portal hypertension. [https://doi.org/10.1016/j.jhepr.2025.101670](https://doi.org/10.1016/j.jhepr.2025.101670) © 2025 The Author(s) . Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL) . This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). JHEP Reports, 2026, 8, 1–9 Research article Liver biopsy quality criteria to exclude cirrhosis in case of suspicion of porto-sinusoidal vascular disorder Chloé de Broucker1 ,2 , Valérie Paradis1 ,3 ,* , Maria Luisa Botero4 ,5 ,6 ,7 , Miguel Albuquerque1 ,3 , Audrey Payancé1 ,2 , Aurélie Plessier1 ,2 , Laure Elkrief8 , François Durand1 ,2 , Sophie Hillaire9 , Paul-Emile Zafar1 ,3 , Juan Carlos Garcia Pagan7 , Pierre-Emmanuel Rautou1 ,2 ,* JHEP Reports 2026. vol. 8 | 1–9 Background & Aims: Baveno VII guidelines based porto-sinusoidal vascular disorder (PSVD) diagnosis on a liver biopsy excluding cirrhosis. However, evidence-based quality criteria for liver biopsy are lacking. This study aimed to determine biopsy length and staining appropriate to rule out cirrhosis. Methods: Liver explants from 12 patients with cirrhosis and 12 with PSVD were selected. Slides were stained with Picrosirius red or Masson’s trichrome. A total of 36,000 virtual liver biopsies were randomly generated, including different biopsy widths (572 and 1,000 μm corresponding to transjugular and percutaneous biopsies, respectively) and lengths (5 mm, 10 mm, 15 mm, 20 mm, 25 mm; fragmented 5 + 10 mm and 5 + 5 + 5 mm) . Biopsies were assessed by an expert pathologist for the presence or absence of cirrhosis. Results: Overall sensitivity of percutaneous biopsies for the diagnosis of cirrhosis was 85%, higher with Picrosirius red (86%) than with Masson’s trichrome (83%) (p <0.001) . Sensitivity increased with the length of percutaneous biopsies, reaching a plateau from 15 mm (88%) . Sensitivity was significantly higher for percutaneous (89%) than for transjugular biopsies (84%) (p <0.001) . A plateau was also observed from 15 mm for transjugular biopsies. Fragmented biopsies with at least one 10-mm-long fragment (5 + 10 mm) had similar sensitivity as 15-mm-long biopsies. Diagnostic accuracy was lower in case of Laennec A cirrhosis, HBV-associated disease, or incomplete septal fibrosis. Validation by a second pathologist gave similar results. Conclusions: For the diagnosis of PSVD, the minimum length of liver biopsy to exclud

FAQs

What is the primary goal of the study regarding liver biopsies in suspected PSVD?

To determine biopsy quality criteria that maximize sensitivity for diagnosing cirrhosis, since ruling out cirrhosis is the first step when PSVD is suspected.

What minimum biopsy length is recommended to exclude cirrhosis in suspected PSVD?

A minimum liver biopsy length of 15 mm, with at least one fragment of 10 mm, is sufficient to exclude cirrhosis.

How do staining method and biopsy route affect sensitivity?

Picrosirius red performs slightly better than Masson’s trichrome for excluding cirrhosis. Percutaneous biopsies show higher sensitivity than transjugular biopsies, although transjugular sampling provides additional pressure-gradient and collateral information.

Sep 29, 2026

Uploaded by Mafia Boss