Since the late nineteenth century, liver biopsy has remained the standard test to assess the etiology and extent of liver disease. Currently, percutaneous puncture biopsies are primarily performed by gastroenterologists/hepatologists or radiologists.
Liver biopsies are generally safe and are currently considered the standard test for assessing liver inflammation and fibrosis, but are inevitably subject to sampling errors, rare complications, and occasionally trigger significant patient anxiety. The above factors have led to a strong interest in the development of non-invasive tests for liver fibrosis. Noninvasive tests have delivered on the promise of reducing the need for liver biopsy, but most hepatologists believe their clinical application is relatively limited. Currently available tests have variable results in detecting progression of intermediate stages of chronic liver disease. Moreover, the lack of validation of these tests is one of their potential drawbacks. The following are indications and contraindications for liver biopsy.
Indications
Liver biopsy, combined with medical history and physical examination data, is an effective clinical tool for the diagnosis and treatment of liver disease. The indications for obtaining biopsy specimens, based on clinical questions, are as follows.
1. abnormal liver laboratory findings.
2, confirmation of diagnosis and prediction.
3, suspected liver tumors.
4, diagnosis of cholestatic liver disease.
5, assessment of infiltrative or granulomatous disease.
6. assessment and management of rejection after liver transplantation.
7, evaluation of unexplained jaundice or suspected drug reactions.
Biopsy specimens may be used to identify or exclude possible etiologies of somatic or laboratory abnormalities. Different diseases may present in the same state and a diagnostic histologic pattern may be used in the context of the clinical presentation. For example, fatty infiltration of the liver parenchyma may be present in diseases due to alcohol abuse, hepatitis C, diabetes mellitus, obesity, etc. For each disease state, histologic clues can distinguish them.
Another use of liver biopsy is to determine the extent of histologic alterations in the biopsy specimen. This involves a scoring system for the degree of inflammation and fibrosis in the liver as indicated by pathologists. Most scoring systems use grading to report the degree of inflammation and staging to report the degree of fibrosis. For example, a moderate inflammatory response (grade 3) versus cirrhosis (stage 4).
A third condition is monitoring disease progression or treatment efficacy. For example, liver biopsy specimens are often used to evaluate and treat rejection after liver transplantation. Repeat biopsies are less often used to monitor disease progression, such as primary biliary cirrhosis, chronic hepatitis C, or alcoholic liver disease.
Contraindications
Contraindications to liver biopsy are as follows:
1. prolonged prothrombin time (PT) with an international normalized ratio (INR) > 1.6.
2, thrombocytopenia with a platelet count <60,000/μL.
3, ascites (preferred transjugular route).
4, difficult body type (transjugular route preferred).
5, suspected hemangioma.
6, suspected endo-peritoneal infection.
7, uncooperative patients.