Understanding Your Liver Pathology Report

When you experience symptoms associated with liver cancer, a biopsy will help confirm your diagnosis.

The biopsy report, also referred to as a pathology report, details the findings after a pathologist examines the extracted tissue sample. The report helps diagnose liver cancer and other liver diseases, and also monitors disease progress and guides treatment decisions. Understanding the various components of this report can empower you to make informed healthcare choices.

A liver biopsy is a medical procedure in which a small sample of liver tissue is extracted for examination under a microscope.

Liver samples are typically obtained through different biopsy techniques.

Percutaneous (needle) biopsy: A thin needle is inserted through the skin into the liver to extract a tissue sample.

Transjugular biopsy: A catheter is inserted into a vein in the neck and guided to the liver to collect a sample, often used for patients with bleeding risks.

Laparoscopic biopsy: A small incision is made in the abdomen, and a camera-guided instrument is used to take tissue samples.

Biopsy during surgery: A biopsy may also be conducted concurrent with liver surgery. The liver tumor is removed along with a margin of tissue around the tumor. The margin is examined to determine if all the cancer has been removed, and samples of the liver tumor are sent for further assessment.

A liver pathology report consists of several sections, each providing specific information about the liver tissue examined.

Clinical information

This section provides background details, including your medical history, symptoms, prior liver conditions, and the reason for performing the biopsy. If you have begun or undergone treatment before the biopsy, this will also be indicated.

Macroscopic description

This describes the liver sample's physical characteristics and how it appears to the naked eye. Details include the size, shape, color, and texture of the sample. It helps pathologists identify any visible abnormalities. These details alone, however, are not crucial in understanding your diagnosis.

Microscopic description

The microscopic description explains the findings from observing the tissue sample under a microscope. It describes the cellular structures, presence of fibrosis, inflammation, or signs of infection.

Tumor cell types

The report also provides information on the cells found in the tissue sample and whether these are cancerous. If a tumor is present, this section specifies the type of cancerous or non-cancerous cells found. The three most common liver cancer types are:

Hepatocellular carcinoma: Cancer that begins in the hepatocytes — cells that make up about 80% of the liver’s mass.

Intrahepatic cholangiocarcinoma: This cancer type occurs in cells that line the bile ducts in the liver.

Angiosarcoma and hemangiosarcoma: This fast-growing cancer type begins in the blood vessels in the liver, and is usually harder to treat.

Histological grade

The histological grade of a cell, as defined by the National Cancer Institute, refers to “how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread”.

Histological grading of liver biopsies is used to assess the degree of inflammation and fibrosis in various liver diseases, particularly in chronic conditions like viral hepatitis and non-alcoholic fatty liver disease. Each liver cancer type has a different histological grading system.

Depth of invasion

In other biopsy reports, this section usually describes how deeply cancer has spread from the point of origin into other tissue and surrounding structures. However, for liver biopsies, this may not be included as some liver cancer types typically grow in a diffuse or nodular pattern rather than infiltrating deeply in a layered fashion.

Lymphovascular invasion

Besides the liver tissue sample, the pathologist will also check the surrounding blood vessels and lymphatic vessels for any cancer cells. Cancer cells found in the lymphovascular system can be an indication of lymph node metastasis, or metastasis to further organs.

Lymph nodes

If lymph nodes were sampled, this section reports whether cancer has spread to them, which is crucial for staging the disease. However, if cancer is confined to the liver, lymph nodes are not usually sampled unless there is suspected spread.

Margins

In some instances, a margin of tissue may be extracted together with the liver sample. This segment of the report would describe whether the tumor was completely removed with clear margins or if cancerous cells remain at the edges. The findings would affect further treatment decisions.

If you receive a liver pathology report with a serious diagnosis or unclear findings, seeking a second opinion from another pathologist or specialist can provide confirmation and additional insights. A second opinion may help clarify uncertain results, explore alternative diagnoses, or refine treatment options. Consider consulting a hepatologist, oncologist, or another pathology expert to ensure you receive the most accurate diagnosis and best possible care.

Understanding your liver pathology report can help you and your healthcare provider make informed decisions about your health. If you have any concerns about your report, do not hesitate to ask your doctor for clarification or seek further consultation.