The normal adult human liver biopsy: a quantitative reference standard

In assessing adult human liver histology, questions remain concerning the normal number of portal tracts and bile ducts in a liver biopsy. We therefore reviewed liver biopsies obtained with use of a percutaneous Menghini cutting needle (14G, internal diameter 1.6 mm), from 16 patients undergoing liver biopsy for screening procedures (age 49 +/- 14 years, +/-SD) and found to be normal by histological examination. The average aggregate length of the liver tissue was 1.8 +/- 0.8 cm (area of 16.4 +/- 10.7 mm2), representing 7 +/- 3 tissue fragments. Portal triads containing at least one profile each of a portal vein, hepatic artery, and interlobular bile duct numbered 11 +/- 6 per biopsy (range 3-23). Portal dyads, which did not contain one of these profiles, usually the portal vein, numbered 8 +/- 5 (range 1-18). On a per-specimen basis, 38% of portal tracts did not contain a portal vein, 7% did not contain a bile duct, and 9% did not contain a hepatic artery. Because of multiplicity of profiles within portal tracts, however, the average number of profiles per portal tract was 6 +/- 5 (range 2-35). Notably, on average there were 2.3 +/- 2.2 interlobular bile ducts per portal tract, compared to 2.6 +/- 2.3 hepatic arteries and 0.7 +/- 0.7 portal veins. The average minimum external diameter of interlobular bile ducts was 13 +/- 4 microm, of hepatic arteries 12 +/- 5 microm, and of portal veins 35 +/- 25 microm. Bile ducts greater than 30 microm in diameter were rare, only one each in two biopsies were observed. In contrast, probable canals of Hering were occasionally evident at the periphery of portal tracts (6 +/- 6 per biopsy) and within the lobular parenchyma as strings of cuboidal cells (5 +/- 5 per biopsy). We conclude that, although multiplicity of profiles is normal, portal dyads are almost as common as portal triads in normal peripheral liver tissue. On average, there are two interlobular bile ducts, two hepatic arteries, and one portal vein per portal tract, with 6 full portal triads per linear cm of tissue obtained by external Menghini biopsy technique with use of a 14G needle, equivalent to 0.8 +/- 0.5 portal triads per mm2. By serving as a reference standard for adult human liver histology, these findings may assist in the histopathological assessment of liver biopsies, particularly those performed for disease conditions featuring loss of intrahepatic bile ducts.