Percutaneous liver biopsy

Abstract

A liver biopsy specimen for histological evaluation represents an important part of the clinical and laboratory work-up in any chronic liver disease and the monitoring of liver transplant grafts [56]. Although biochemical, serological and molecular biological tests, as well as non-invasive procedures such as elastography and laboratory scores have been continually improved, histology still remains the gold standard for many questions regarding liver diseases [9]. However, indications and the techniques employed have seen considerable changes since liver biopsy was first performed [50]. The first liver biopsy obtained by aspiration was performed by Paul Ehrlich in 1883 to assess hepatic glycogen content in a diabetic patient, and 12 years later by Lucatello to analyze a tropical abscess of the liver. Its first application for the diagnosis of liver cirrhosis in humans and rats was published in a series by Schüpfer in France in 1907, and the diagnostic potential was expanded by Bingel in Germany in 1923. Over the next 50 years the technique of obtaining liver biopsy samples was further developed in regard to approach, needle type and the combination with diagnostic imaging techniques such as ultrasound, computer tomography, angiography and laparoscopy. Since the publication of a "one second needle biopsy of the liver" by Menghini in 1958, the technique of liver needle biopsy has seen a broad introduction into clinical non-operative medicine and is performed by experienced fellows and hepatologists on a daily basis in hepatology centers [40, 50]. Although the etiology of most chronic liver diseases can be diagnosed by currently available biochemical, serological, immunological and molecular biological tests, histological evaluation remains firmly integrated into the management of chronic hepatic disease [57]. Not only are cases of undefined liver diseases subjected to histological analysis, but most importantly the determination of inflammatory activity (grading) and degree of fibrosis/cirrhosis (staging) are relevant for the prognosis of the patient and for the indication for cost intensive as well as potentially side effect prone therapies (e.g. interferon alpha in chronic hepatitis C virus infection) [1]. The increasing number of liver transplant patients within the hepatological spectrum requires regular, safe and high quality biopsies as well as their appropriate assessment [17]. In addition, the management of infectious diseases allows for a fast and sensitive discovery of mycobacteria or viruses in hepatic tissues, i.e. in HIV-infected patients and in patients with granulomatous diseases. The determination of copper and iron content in hepatic tissue can be achieved in biopsies from patients with hereditary storage diseases such as hemochromatosis and Wilson's disease. Additionally, important clues to the etiology and for the further management of diseases such as alpha-1-antitrypsin deficiency, amyloidosis, unclear space occupying lesions, or suspected drug toxicity are reached [6, 24, 29, 33]. In view of these considerations liver biopsies are of considerable importance. In clinical practice, the hepatologist must not only determine the method by which to biopsy the liver, but also weigh the attendant risks with the probability of obtaining information that will answer clinical questions and lead to a modification or initiation of a therapeutic approach [53, 54]. © Springer-Verlag Berlin Heidelberg 2010.