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 following removal of the initiating agent or with therapeutic intervention. Reversal of established cirrhosis has also been documented. Studies of fibrosis reversal utilize semiquantitative staging which was developed for progressive disease and which is limited by its categorical nature. A more nuanced system, the Beijing P-I-R classification is only validated in viral liver disease. The clinical significance of regressive features is hitherto unstudied. In this brief review, we are addressing shortcomings in (i) the histological assessment of fibrosis regression across the whole spectrum of common chronic liver diseases and (ii) identification of a point of no return in advanced fibrosis and argue that the hepatopathologists' community should rise to such challenges, perhaps hastened by development of artificial intelligence solutions applied to liver biopsies.