The evolving role of liver biopsy

Abstract

Summary Liver biopsy is traditionally the ‘gold standard‘ for the evaluation of liver diseases. There are several situations in which its role is being challenged. In hepatitis C, liver biopsy helps assess prognosis and treatment candidacy. An important exception is genotype 2 or 3 because treatment is more likely to succeed and therapy is relatively short in duration. For hepatitis B, liver biopsy gives some prognostic information, but serologic tests and hepatic biochemical tests are the primary determinants of treatment candidacy. Non‐alcoholic fatty liver disease can be accurately diagnosed without a liver biopsy and, furthermore, there are no specific therapies available. The role of liver biopsy to assess methotrexate‐associated hepatotoxicity remains controversial. Finally, patients with focal liver lesions usually do not require biopsy and, in the case of hepatocellular carcinoma, biopsy carries a risk of needle‐track seeding. In short, the need for liver biopsy depends on the specific situation and should be performed when there is sufficient uncertainty about diagnosis, severity of disease, prognosis, and treatment decisions.

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

“…[26][27][28][29] A separate informed consent for liver biopsy was required. Patients were proposed for transjugular liver vein catheterization and biopsy whenever this was possible from a logistic point of view.…”

Percutaneous Liver Biopsies: Safety and Efficacy

“…The hemog rams, prot hrom bin ti mes, in ter na ti o nal norma li zed ra ti os and ac ti va ted par ti al throm bop las tin ti mes of all pa ti ents we re chec ked be fo re the pro ce du re. The li ver bi op si es we re perfor med in an out pa ti ent set ting with a stan dard met hod: fol lo wing one-night fas ting, the punc ture si te was marked in the intercostal region at the best se en part of the best-thic kest liver dis tant Turkiye Klinikleri J Med Sci 2010;30 (4) from the ad ja cent or gans ul tra so und and the biopsy was performed by ex pe ri en ced gas tro en te rolo gists. No mo re than 1 min was ne ces sary for such a de ter mi na ti on.…”

“…es pi te the ad van ces in ima ging tech ni qu es and se ro lo gi cal in ves ti ga ti ons, in many liver di se a ses, li ver bi opsy is still a gold standart to di ag no se, prog nos ti ca te, and help to de ter mi ne the tre at ment. [1][2][3][4][5][6][7][8][9][10] Alt ho ugh li ver bi opsy has be en ac cep ted as a sa fe pro ce du re, so me compli ca ti ons may oc cur in up to 5% of the pa ti ents, inc lu ding pa in re qu i ring hos pi tal ad mis si ons (1-5%), fa i lu re to ob ta in tis su e (2%), ble e ding re qu i ring trans fu si on (0.3%), ble e ding re qu i ring sur gery (0.04%), pne u mot ho rax (0.35%), and ob ta i ning other tis su es (0.5%). 1,2,5,11 The comp li ca ti ons of per cuta ne o us li ver bi opsy ha ve be en classified as mi nor (pa in, tran si ent hypo ten si on) and ma jor (sig ni fi cant hypo ten si on, pne u mot ho rax, he mot ho rax, he mope ri to ne um, he mo bi li a, in tra he pa tic he ma to ma, car di ac arrhy thmi a, gall blad der per fo ra ti on, punctu re of the kid ney, co lon or pan cre as) comp li ca tions.…”

Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis

“…Although laboratory methods used in the diagnosis of chronic hepatitis partially assess necroinflammation in the liver tissue, it does not give information on fibrosis. Today, liver biopsy is still the gold standard in determining liver fibrosis and necroinflammatory activity [2][3][4].…”