Chapter 33 LIVER BIOPSY
• Since liver biopsy is an invasive procedure, the procedure requires appropriate precautions and informed consent.
• Safety warrants that patients should ideally have a normal (or close to normal) coagulation profile.
BIOPSY METHODS
Indications
• Diagnosis of abnormal liver tests, usually after at least 6 months of inconclusive serological tests.
• Diagnosis of non-alcoholic steatohepatitis (NASH), autoimmune hepatitis and alcoholic liver disease.
Percutaneous biopsy of a neoplastic lesion has the small potential for seeding, and is therefore not usually performed. A lesion >2 cm with a high alpha-fetoprotein (AFP) in serum is highly sensitive for malignancy.
Biopsy is the only method of assessing fibrosis in NASH (see Chapter 39). Patients with a BMI >30 kg/m2, diabetes or age >45 years should be biopsied. Up to 20% of NASH patients will have severe fibrosis.
Diagnosis of viral hepatitis or NAFLD does not require biopsy.