Fibrosis regression in chronic liver disease: The pathologist’s view

Numerous observations have indicated that significant amounts of liver fibrosis can either completely disappear or be substantially remodelled after removal of the initiating agent or following effective therapeutic intervention. Reversal of established cirrhosis has also been documented. Studies of fibrosis regression have largely used semiquantitative staging systems that were developed to assess progressive disease and are limited by their categorical nature. A more nuanced system, the Beijing P-I-R classification, has been validated only in viral liver disease. The clinical significance of regressive features remains largely unstudied. In this brief review, we address shortcomings in (i) the histological assessment of fibrosis regression across the spectrum of common chronic liver diseases and (ii) the identification of a 'point of no return' in advanced fibrosis. We argue that the hepatopathology community should rise to these challenges, perhaps aided by the development of artificial intelligence solutions for the assessment of liver biopsies.