Prognostic significance of bridging necrosis in chronic active hepatitis

A retrospective study of 307 patients with chronic active hepatitis (CAH) was conducted to assess the prognostic significance of bridging necrosis (BN). BN was encountered in 70 (22.8%) of 307 patients with CAH. Twenty six cases of CAH with BN and 40 of CAH without BN were followed up with repeated liver biopsies for periods of from 6 months to 12 years. Twelve (46.1%) of the 26 CAH cases with BN developed cirrhosis including 4 cases of early cirrhosis. Seven cases had no sequential histologic changes. Histologic improvement to CAH or to chronic inactive hepatitis (CIH) was seen in 3. On the other hand, one (2.5%) of 40 CAH cases developed cirrhosis and 3 early cirrhosis. Another 3 cases histologically showed aggravation to CAH with BN, two of which developed in a short period after the initial biopsy and the possibility of sampling error in the initial biopsy cannot be ruled out. There were no sequential histologic changes in 26 of the 40 cases. Histologic improvement to nonspecific reactive hepatitis or to CIH was seen in 7. From these findings, it may be concluded that the presence of BN in CAH holds prognostic implications.