The utility of liver biopsy in 2020

Abstract

Purpose of review Over the past decade, imaging modalities and serological tests have emerged as important tools in the evaluation of liver diseases, in many cases supplanting the use of liver biopsy and histological examination. Nonetheless, the accuracy and diagnostic value of these methods may not always be conclusive and the assessment of liver histology often remains the gold standard for diagnostic evaluation. The purpose of this review is to summarize the current role of liver biopsy in contemporary hepatology practice. Recent findings Technical factors were found to influence the diagnostic value of liver biopsy and histological examination of the liver, including specimen number and size (preferably ≥3 nonfragmented specimens of >20 mm in length), needle diameter (1.6 mm Menghini), number of passes (mean 2.5), imaging-guidance, and operator experience. Liver biopsy was demonstrated to be diagnostically valuable in the evaluation of persistently abnormal liver tests of unclear cause, with histology pointing to a specific diagnosis in 84% of patients. Although coagulation abnormalities continue to be an important concern when performing liver biopsy, their influence on complication risk remains unclear. Implementation of less stringent preprocedural coagulation thresholds decreased preprocedural transfusions without increasing the bleeding rate. Serious complications associated with percutaneous liver-biopsy (PLB) and transjugular liver-biopsy are similar, but pain appears to be more common with PLB. Summary Histopathological evaluation continues to be fundamentally important in assessing hepatic disease, and liver histology remains the most accurate approach to assess fibrosis and assign prognosis.

Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

“…Following recent improvements in non-invasive tests, the indications for liver biopsy have decreased, although histology still remains invaluable in diagnosis and management of selected patients. 7 There is no consensus on best practice.…”

Insulin resistance and liver histopathology in metabolically unhealthy subjects do not correlate with the hepatic abundance of NLRP3 inflammasome nor circulating IL-1β levels

“…To further control the histological quality of the biopsies included in this study, only samples with at least 11 complete portal tracts were analyzed. [37][38][39] Liver samples were immediately separated into three pieces: one was stored in RNAlater storage solution; a second was snap-frozen in liquid nitrogen and stored at −80°C; and a third was fixed in formaldehyde for histological analyses.…”

Need for analgesia after percutaneous liver biopsy: a real-life experience

“…For focal lesions or masses, a tissue core obtained through biopsy for histological analysis provides optimal conditions for further tissue processing, such as a more refined immunohistochemical analysis ( 8 , 9 ) . The current methods for obtaining liver tissue samples are percutaneous, transjugular, endoscopic and laparoscopic biopsy ( 3 , 10 - 12 ) . Among the percutaneous methods, the most widely used are sheathed (Tru-Cut) needle biopsy, suction (Menghini) needle biopsy, and, less commonly, fine-needle aspiration biopsy ( 1 , 13 , 14 ) .…”

“…The use of imaging guidance has improved the accuracy of percutaneous procedures and decreased complication rates ( 3 , 14 ) . Although a variety of imaging guidance methods can be used, the most popular methods are ultrasound and computed tomography (CT), the former, as depicted in Figure 1 , being used in over 96% of procedures ( 12 , 15 ) .…”