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 diseases. Depending on the clinical question, the indications for obtaining a biopsy specimen are as follows:

1. Abnormal liver laboratory test results;

2. Confirm diagnosis and prediction;

3. Suspected liver tumor;

4. Diagnosis of cholestatic liver disease;

5. Evaluation of invasive or granulomatous disease;

6. Evaluation and management of rejection after liver transplantation;

7. Assess for unexplained jaundice or suspicious drug reactions.

Biopsy specimens can be used to identify or rule out possible causes of physical or laboratory abnormalities. Different diseases may present the same state and diagnostic histological patterns can be used in the context of clinical presentation. For example, fatty infiltration of liver parenchyma may be present in diseases due to alcohol abuse, hepatitis C, diabetes, obesity, etc. For each disease state, histological clues can differentiate them.

Another use of liver biopsy is to determine the extent of histological changes in biopsy specimens. This involves a scoring system for the degree of inflammation and fibrosis in the liver as pointed out by the pathologist. Most scoring systems report the degree of inflammation using grades and fibrosis using staging. For example, moderate inflammation (grade 3) versus cirrhosis (stage 4).

A third situation is monitoring disease progression or treatment effects. For example, liver biopsy specimens are often used to evaluate and treat rejection after liver transplantation. Repeat biopsies are less frequently used to monitor disease progression, such as primary biliary cirrhosis, chronic hepatitis C, or alcoholic liver disease.

Contraindications

Contraindications for liver biopsy are as follows:

1. Prothrombin time (PT) prolonged, international normalized ratio (INR) > 1.6;

2. Thrombocytopenia, platelet count <60,000/μL;

3. Ascites (preferred via the jugular vein);

4. Difficult physique (preferably via the jugular vein);

5. Suspected hemangioma;

6. Suspected hydatid infection;

7. Uncooperative patients.

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