Preface

Chapter 7 **Primary and Metastatic Tumours of the Liver: Expanding Scope of Morphological and Immunohistochemical Details**

Sulte, Zane Simtniece, Arnis Abolins and Janis Gardovskis

Chapter 8 **Nonalcoholic Fatty Liver Disease: A Pathological View 161** Joaquín Cabezas, Marta Mayorga and Javier Crespo

Alpna R. Limaye, Lisa R. Dixon and Roberto J. Firpi

Chapter 9 **Liver Biopsy After Liver Transplantation 189**

**Section 3 Non-Invasive Alternatives of Liver Biopsy 207**

**with Heroin Abuse and**

Hiroyasu Morikawa

Chapter 10 **Non-Invasive Evaluation of Liver Steatosis, Fibrosis and**

**Coinfection (Tuberculosis, HCV, HIV) 235** Ivan B. Tokin, Ivan I. Tokin and Galina F. Filimonova

**Basis of Virtual Microscopy 257**

Andrejs Ivanovs and Valentina Sondore

**Evaluation of Hepatic Fibrosis 281**

**Cirrhosis in Hepatitis C Virus Infected Patients Using Unidimensional Transient Elastography (Fibroscan®) 209** Monica Lupsor, Horia Stefanescu, Diana Feier and Radu Badea

Chapter 11 **Computer Image Analysis of Liver Biopsy Specimens in Patients**

Chapter 12 **Future Aspects of Liver Biopsy: From Reality to Mathematical**

Chapter 13 **Real-Time Tissue Elastography and Transient Elastography for**

Ludmila Viksna, Ilze Strumfa, Boriss Strumfs, Valda Zalcmane,

Ilze Strumfa, Janis Vilmanis, Andrejs Vanags, Ervins Vasko, Dzeina

**in the Biopsy 115**

**VI** Contents

Liver biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. Liver biopsy may be used to evaluate a mass seen on ultrasound, CT or MRI images, diagnose unexplained liver diseases or abnormal liver function tests, determine the severity of the liver diseases including non-alcoholic liver disease, certain liver disease such as chronic hepatitis B or C, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, hemochromatosis or Wilson's disease, and monitor the liver after a liver transplantation. Liver biopsy is a safe procedure when performed by an experienced doctor. However, it is an invasive procedure, and the common problems include mild pain and a decrease in blood pressure. Although more serious complications such as bleeding, infection, and injury of nearby organs are rare but potentially lethal, the monitoring within 24 hours after the liver biopsy is important. This book describes the role, indication, contraindication, technique and evaluation of outcome of liver biopsy. I believe that it will be greatly useful to the readers. Furthermore, this book introduces transgastric liver biopsy using NOTES technique and non-invasive alternatives including elastography and computer analysis of liver fibrosis as new tools for the evaluation of liver diseases.

> **Nobumi Tagaya, M.D., Ph.D.** Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan

**Section 1**

**An Overview and Future Aspects of Liver Biopsy**

**An Overview and Future Aspects of Liver Biopsy**

**Chapter 1**

**Liver Biopsy -**

Piero Luigi Almasio

**1. Introduction**

complications.

http://dx.doi.org/10.5772/52616

**Indications, Procedures, Results**

Additional information is available at the end of the chapter

Liver biopsy (LB) is the most common procedure performed in clinical hepatology. His‐ tological assessment of the liver, and thus, LB is traditionally the "reference standard" in the diagnosis and management of parenchymal liver diseases. Definitive diagnosis of‐ ten depends on LB, and much of understanding of the characteristic features and natu‐ ral history of liver diseases is based on information obtained by serial liver biopsies. During the last 60 years as the result of a better understanding of liver disorders, ap‐ pearance of newer entities and advent of novel hepatic imaging techniques, the indica‐ tions for LB have evolved. Whereas in the past LB was often performed as the initial investigation in the workup of liver disease of unknown aetiology, today the most com‐ mon indication for LB includes staging of chronic hepatitis. A variety of methods exist for getting a liver tissue specimen. These take account of a percutaneous method, a transvenous (transjugular or transfemoral) approach, and intra-abdominal biopsy (laparo‐ scopic or laparotomic). All LB techniques require specific training so as to ensure appro‐ priate-sized specimen retrieval and the lowest rate of complications. However, because LB is an invasive procedure that carries a definite, albeit small, risk of complications, controversy persists with regard to its precise indications in various clinical situations, its clear contraindications, the optimal technique for its performance (and whether cer‐ tain modifications improve its safety), and training requirements for clinicians. The aim of this chapter will be summarize the existing clinical practice of LB with an emphasis on the technique, indications, contraindications, quality of LB specimens and risk of

> © 2012 Randazzo et al.; 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.

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,

Claudia Randazzo, Anna Licata and
