The evaluation of liver biopsies in suspected drug-induced liver injury (DILI) can be complex. The biopsy may be approached systematically, by identification of histologic lesions and then identification of the overall pattern of injury. Potential DILI must be separated from concomitant non-DILI liver disease. The findings can be analyzed with respect to the various prescription and nonprescription medications and dietary supplements under suspicion to provide a complete interpretation of the findings. The pathologic findings, the histologic differential diagnosis, and expert interpretation are part of a complete biopsy assessment and provide information that is of greatest value in patient management.
Key points
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Hepatic pathology in drug-induced liver injury is complex, but may be approached systematically.
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Biopsy assessment begins with objective evaluation of the character and severity of histologic changes.
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The histologic findings are summarized as a pattern of injury that generates the histologic differential diagnosis.
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The pathologist provides an expert interpretation of the findings in light of the patient’s medical and drug history.
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