**1. Introduction**

Indications and methods of liver biopsy have changed over the past few years [1]. However, an histological diagnosis may be needed for optimal management of a patient [2, 3].

Although modern biochemical, immunological, and radiographic techniques have facilitat‐ ed the diagnosis and management of liver diseases they have not made liver biopsy obso‐ lete. Clinicians rely on information derived from the liver biopsy to inform patients and to make their therapeutic options [4].

There are, however, many controversies surrounding liver biopsy resulting potential limita‐ tions, such as sampling errors and interobserver variations [5], which can lead to misclassifi‐ cation therefore, P. Bedossa et al. consider that when it comes to liver biopsy the term ''best" standard is more appropriate than ''gold" standard [6].

It is essential, when analysing the indications, contraindications, complications and other as‐ pects of the liver biopsy, to consider present hepatology and personalized medicine.

Practiced since the late 19th century, liver biopsy remains the criterion standard in the evaluation of the etiology and extent of disease of the liver. Paul Ehrlich performed a per‐ cutaneous liver biopsy in Germany in 1883. [7]. Since then, this method has been im‐ proved with the introduction of different needle types for cutting and aspiration. But, until the 1950s, when Menghini developed an aspiration technique which led to a wider use of the procedure and broadened its applications, it was not common. While in the ear‐ ly 1960 and 1970s the liver biopsy was used for making a diagnosis in cases of suspected medical liver disease, today it is more often performed to assess the prognosis or evaluate therapeutic strategies [1].

© 2012 Casanovas Taltavull; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

With regards to the technique used to carry out the liver biopsy there has also been a major change, it used to be performed blindly by clinicians, specialists in gastroenterology or hep‐ atology at the patient's bed whereas at present, percutaneous biopsies are performed pri‐ marily by radiologists.

ing, prothrombin time 3–5 seconds more than control, platelet count less than 50,000/

**Relative contraindications:** Morbid obesity, ascites, hemophilia, infection in the right pleu‐

**Accepted indications:** Given the new developments that have proved the efficacy of liver biopsy, its role in the management of patients with chronic liver diseases has much evolved in recent years and will continue to evolve as new non invasive technologies are developed.

• Absolute: uncooperative patient, severe coagulopathy, infection of the hepatic bed, extrahepatic biliary obstruction.

Its importance in diagnosis, staging and prognosis largely depends on the indication and the

The utility of routine liver biopsy has been the subject of debate in recent years. Due to liver biopsy being associated with a small but definite risk, a biopsy should only be performed when the findings contribute to a better management of the patient. It is argued that for the purposes of management, liver biopsy is neither needed in cases with advanced fibrosis nor those diagnosed with cirrhosis by other methods, nor in patients with mild disease, for whom a therapeutic decision is not urgent. Until recently, liver biopsy played a key role in the evaluation of chronic liver disease, but now in the presence of better diagnostic tests on disease etiologies and treatments its role has to be re-evaluated. Recognition and confirma‐ tion of the pattern of injury (chronic hepatitic, chronic cholestatic, steatohepatitic, etc.) is the

, the use of a non-steroidal anti-inflammatory drugs, (unless discontinued 7 to 10 days previously), blood for transfusion unavailable, suspected hemangioma, another vas‐ cular tumor or echinococcal cysts in the liver, and the inability to identify an appropriate

Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

http://dx.doi.org/10.5772/53120

35

mm3

site for biopsy.

• Diagnosis

1. Many parenchimal liver diseases

4. Focal or diffuse abnormalities on imaging studies • Prognosis-Staging of known parenchimal disease

Contraindications for percutaneous liver biopsy

**2.1. Is liver biopsy always necessary?**

**Table 1.** Indications and contraindications for liver biopsy

• Management –Developing treatment plans based on histologic analysis

• Relative: ascites, morbid obesity, possible vascular lesions, amyloidosis, hydatid disease.

clinical question relying on an answer from the histological result.

pathologist's priority when evaluating the liver biopsy.

2. Abnormal liver tests 3. Fever of unknown origin

ral cavity or below the right hemidiaphragm.

Currently, a liver biopsy can be obtained either transvenously or transcutaneously, or by combining imaging modalities such as ultrasound, computed tomography, and laparosco‐ py. The choice of one technique over another is based on availability, personal preference, and the clinical situation.

Liver biopsy techniques: Percutaneous, transjugular or laparoscopic


The decision to use a particular technique is based on the risk profile of the patient. If he or she has advanced liver failure with coagulopathy and ascites, liver biopsy is unnecessary, but the diagnosis of the underlying disease is crucial in specific circumstances in order to determine a therapy, for example in cases of liver transplant. Before a liver biopsy it is nec‐ essary to carry out an ultrasound to quantify vascular permeability and because it may rule out anatomical abnormalities and can identify mass lesions that are clinically silent. When cirrhosis is suspected on clinical grounds, or by non-invasive methods liver biopsy is usual‐ ly avoided.
