Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

Abstract

Background: Liver biopsy (LB) has been used as diagnostic modality in liver diseases (LD). Over last two decades, there has been remarkable improvement in understanding of natural history, molecular diagnostics of viral hepatitis, genetic of LD, and also limitations of LB. There is current trend in avoiding LB in the management of various LDs. Aim: To determine utility of LB in clinical practice. Material and Methods: In a prospective study, 2413 patients of LD were followed up, 219 (9%) were acute, and remaining 2194 (90.9%) were chronic LD. Patients were evaluated by biochemical parameters, virological studies, and imaging endoscopy as and when required. LB was performed in 176 (7.2%) patients when no conclusion could be drawn from the noninvasive workup. Patients with platelet count <50,000/cm 2 , ascites, and overt bleeding were excluded. Patients with international normalization ratio (INR) more than 1.5 were not excluded. No prophylactic use of fresh frozen plasma and platelet transfusion was done. There was no major complication related to the procedure. Indications for LB were as follows: cryptogenic LD 38 cases, hepatitis B infection 35, suspected autoimmune hepatitis 30, mass lesion in the liver and lymphoma 29, evaluation of portal hypertension 15, elevated liver enzymes 11, hepatitis C infection 9, and drug-induced LD 4, and miscellaneous 5 cases which were primary biliary cholangitis, primary sclerosing cholangitis, cholestatic LD, sarcoidosis, and amyloidosis. Results: LB changed the diagnosis in 55 (31.2%). These were cryptogenic LD in 24 cases, portal hypertension 15, elevated liver enzymes 11, and 5 others. In remaining, LB confirmed clinical diagnosis and helped in making management decisions. Conclusion: LB was required in 7.2% of patients with chronic LD. In 31.2% cases, LB changed the diagnosis. LB was a safe procedure even in presence of low platelet count and abnormal INR. ( J CLIN EXP HEPATOL 2015;5:314-319)

Hepatopathy of unknown etiology – is liver biopsy a good tool in differential diagnosis?

“…The microscopic analysis of biopsy specimen made it possible to establish steatosis zonality, fat droplet size (macro and microvesicular), inflammation, cellular injury and fibrosis. In the present trend of non-invasive assessment of liver fibrosis, liver biopsy is still required in at least 7.2% of patients with chronic liver diseases [1]. A major limitation of liver biopsy is lack of representation as a whole organ, depending on sampling variability [1].…”

“…Liver biopsy has been considered as a gold standard for the diagnosis and evaluation of chronic diffuse liver diseases for many years, despite the fact that this is an invasive test and complications can occur. Several potential limitations of the liver biopsy have been described, such as the fact, that various areas of the liver can be affected to different degrees, sampling errors, discordance in the interpretation of the histological findings or lack of acceptability of the biopsy by the patient [1]. Usually the first liver biopsy is recommended to establish the diagnosis of chronic liver diseases and consecutive biopsies are sometimes necessary to evaluate hepatic changes in the course of the disease, as aminotransferase activity is not always a reliable marker for inflammation and fibrosis [2] and the FibroTest and transient elastography assess only fibrosis [3, 4].…”

Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

“…Percutaneous liver biopsy (PLB) is the definitive procedure for the diagnosis of a variety of hepatobiliary disorders providing high diagnostic yield and generally low complication rates in children [12]. Increasingly, the procedure is performed with ultrasound guidance in an outpatient setting with local anesthesia and moderate sedation [34567]. Post-procedural monitoring includes assurance of anesthetic recovery, adequate pain control, and observation for known procedural related complications [8910].…”

An integrated microfluidic system for hepatotoxicity assessment based on gene expression profiling : from tissue homogenization to RT-PCR

“…Figure 1-1 depicts the typical procedure ('supply chain') for LB. In Step 3, the visual examination provides an assessment of the stage of the fibrosis as well as the severity of the liver disease, necessary for ensuing therapeutic management [14]. As the samples include actual liver tissue, the diagnosis from LB features a lower degree of uncertainty and consequently, higher accuracy (than LFTs).…”

“…Secondly, it is a relatively expensive procedure due to the complex infrastructure (medical equipment and expertise) and the longer processing time (to prepare the sample for the aforementioned pathologist's visual examination, and complex logistics, see Figure 1-1). Thirdly, the results of the diagnosis largely depend on the pathologist's interpretation of the biopsy specimen [14].…”