Sampling variability of liver biopsy in nonalcoholic fatty liver disease.

By V. Ratziu, F. Charlotte, A. Heurtier, Sophie Gombert, P. Giral, E. Bruckert, A. Grímaldi, F. Capron, T. Poynard. Gastroenterology, 2005

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Magnetic Resonance Imaging More Accurately Classifies Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease Than Transient Elastography. (2016, background): “Furthermore, the histologic lesions of NASH are unevenly distributed throughout the liver parenchyma; therefore, liver biopsy sampling error can result in substantial stratification and staging inaccuracies [9].”
A position statement on NAFLD/NASH based on the EASL 2009 special conference. (2010, background): “Inflammatory lesions and ballooning are highly prone to sampling error as are fibrosis and steatosis which can result in misdiagnosis or understaging [138,139].”
Quantifying hepatic shear modulus in vivo using acoustic radiation force. (2008, background): “While core biopsy is considered to be the current gold standard for evaluating liver health, its accuracy is limited by a small sample size, with misdiagnosis in fibrosis staging reported in 20–40% of cases (Ratziu et al., 2005; Regev et al., 2002; Bedossa et al., 2003).”
Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. (2015, background): “nosis of disease activity and fibrosis stage at either biopsy [38].”