Hepatitis C Survivor  

The Liver Biopsy - How To Interpret The Results

Written By:  Teri Gottlieb


So you've gone in for that liver biopsy and realized what a pleasant experience that is... Okay, I am being sarcastic.  There is nothing inherently good about having a biopsy.  The entire procedure tends to freak people out and it's not fun at all, but it's an important piece in the puzzle...  So you've done it and hopefully come out unscathed and now you have the results.  What do they mean?  Hopefully this will help.  

Liver Biopsy: Grading & Staging - There are a couple of different ways to read a liver biopsy. The most common scoring methods are known as the Metavir and the Knodell Score. It is important to remember that the size and the location of the piece of liver taken at biopsy can affect the report. The knowledge of the doctor reading the biopsy is also important.


The Metavir scoring system was set up just for patients with hepatitis C. The scoring uses both a grade and a stage system.  The grade tells you about the activity or amount of swelling and irritation (inflammation).  The stage tells you the amount of fibrosis or scarring.  The grade is given a number based on the amount of inflammation. This is usually scored from "0-4." 

  • Grade 0 =  no activity, no swelling or irritation
  • Grade 1 =  some low level swelling and/or irritation
  • Grade 2 =  moderate activity, some swelling and irritation present.
  • Grade 3 =  moderate to severe swelling and irritation.

The amount of inflammation is important because it may lead to eventual scarring or damage.The fibrosis score is also assigned a number from 0-4:

  • 0 = no scarring
  • 1 = minimal scarring
  • 2 = scarring has occurred and is inside the areas of the liver including blood vessels
  • 3 = bridging fibrosis (the fibrosis is spreading and connecting to other areas that contain fibrosis)
  • 4 = cirrhosis or advanced scarring of the liver


The Knodell score or HAI (histologic activity index) is also commonly used to stage liver disease. It is a bit more complex a process than using the Metavir score. But some experts believe that it is a better at finding how much liver inflammation and damage are present. It has four different numbers that make up a single score. The addition of these numbers tells the amount of inflammation in the liver:

  • 0 = no inflammation
  • 1-4 = minimal inflammation
  • 5-8 = mild inflammation
  • 9-12 = moderate inflammation
  • 13-18 = marked inflammation

The fourth part of the score deals with the amount of scarring in the liver and is scored from 0 (no scarring) to 4 (extensive scarring or cirrhosis).