Current Trends in Liver Biopsy Indications for Chronic Liver Diseases

At the present time, pathological examination of a liver fragment obtained by liver biopsy remains an essential diagnostic tool of numerous chronic liver diseases [1] Indications for liver biopsy (LB) have changed considerably over recent years due to the development of sensitive and specific tests for diagnosis of several chronic liver diseases (i.e., serology for hepatitis C, antimitochondrial M2 in primary biliary cirrhosis, genetic screening for he‐ reditary hemochromatosis), but also because of intensive development during the last dec‐ ade of non-invasive assessment of fibrosis using serum tests (FibroTest®, FibroMeter®, APRI score) and/or by physical methods such as pulsed elastography (FibroScan®), in particular, for chronic hepatitis C. Ultrasound-guided liver biopsy is often necessary to ob‐ tain a tumor fragment in cases of suspected primary or secondary liver malignancy and will not be discussed here [1]. In the present article, we will limit ourselves to indications of liver biopsy in diffuse parenchymal disease of the liver and its relative and absolute contraindications. Modalities for performing liver biopsy and complications will not be discussed here. Liver biopsy is an invasive procedure with possible complications; thus, individual benefits for the patient must be weighed against possible risks. Liver biopsy is indicated when the expected amount of information obtained exceeds the risks related to the procedure, when the diagnosis required for establishing a prognosis cannot be ob‐ tained without pathological examination of the liver, and finally, when the treatment deci‐ sion depends on pathological results [1].