**3. Limitations**

transaminases, possibly combined with the dosage of hyaluronic acid and/or use of Fibro‐ Scan) can indicate the existence or absence of extensive fibrosis and help to guide indica‐

Liver biopsy is often proposed in case of unexplained abnormal liver tests, when physical examination, biochemical and serological tests, imaging investigation could not establish a diagnosis. In one study including 354 patients, non alcoholic fatty liver disease was the defi‐ nite diagnosis in 64 % of the cases. Other lesions included drug induced liver injury, alcoholrelated liver disease, auto-immune hepatitis, primary sclerosing cholangitis,primary and secondary biliary cirrhosis, hemochromatosis, amyloid and glycogen storage disease, and cryptogenic hepatitis [26]. In another study including 272 patients, NAFLD represented 59.5

Liver biopsy is essential for the diagnosis of rare diseases of the liver such as Wilson's dis‐ ease, wherein the hepatic copper concentration has to be measured, a deficiency in al‐ pha-1 antitrypsin with evidence of PAS-positive cells, overload diseases such as Gaucher's disease, and amyloidosis, when there exists no other alternative [2]. In case of amyloido‐ sis, liver biopsy should be performed via the transjugular route, since there is a major risk of bleeding in case of LBP performed via the transparietal route. Liver biopsy also helps in diagnosing rare diseases (nodular regenerative hyperplasia, congenital hepatic fibrosis) in case of prolonged abnormal liver function tests [1]. In case of severe acute hepatitis, emergency liver biopsy performed via the transjugular route may be particularly useful for diagnosing seronegative autoimmune hepatitis, infiltrative lesions of the liver, hepati‐ tis or herpes [1]. Liver biopsy is essential for diagnosis of abnormalities in liver function tests when monitoring patients after liver transplantation in order to give a positive differ‐ ential diagnosis of the following anomalies: rejection, infection, drug-induced liver injury, bile duct injury and viral reinfection. In case of hepatitis C virus recurrence in the liver transplant, liver biopsy is indicated; however, the FibroScan® is currently being assessed for evaluating damage from hepatic fibrosis. In case of suspected drug-induced hepatitis, liver biopsy may be useful if biochemical abnormalities persist beyond 3 months after ces‐ sation of treatment or if there is evidence suggesting injury to the bile ducts, such as a

It is essential that the pathologist be provided with relevant and complete clinical and bio‐ logical information. Such information should be available before performing liver biopsy in suspected cases of rare diseases of the liver, or when bacteriological seeding or special stain‐ ing has to be performed [1], so that the fresh liver fragment is immediately transmitted to

tions for liver biopsy.

108 Liver Biopsy - Indications, Procedures, Results

% of the cases [18].

**2.8. Other indications (Table 3)**

prolonged cholestatic syndrome.

the pathology or microbiology laboratory.

**2.7. Unexplained abnormal liver tests**

Liver biopsy has remained the "gold standard" for years. However, it is imperfect since a large biopsy is required to make an accurate assessment of fibrotic stage and inflammatory grade. Pathologists estimated that a 25 mm-long fragment obtained with a 16-G needle was necessary to accurately determine the grade of chronic liver disease [27]. Colloredo et al. showed that eleven to fifteen complete portal tracts was the minimal number below which disease stage was significantly underestimated [28]. In a large review of the literature including 10,027 LB, Cholongitas et al. showed that the mean ± SD length was 17.7±5.8 mm and the mean ± SD num‐ ber of portal tract was 7.5±5.8 [29]. This implies that at least two passes would be necessary to obtain a 2.5 cm long specimen, thus potentially increasing the risk of complications.
