Description
Generally speaking liver pathology may be studied in many pathologic samples, such as those obtained at autopsy, hepatectomy, partial liver resection, surgical and medical biopsy. The latter two modalities are of greatest signifi cance for the clinicians and accordingly in this book we will mostly discuss the pathology of the liver as seen in liver biopsies.
Indications for Liver Biopsy
Liver biopsy is one of the standard tests performed during the clinical evaluation of many patients suspected of having a liver disease, as well those who have a documented liver disease that needs to be monitored for its progression or its response to treatment. The main function of the liver biopsy is to stage (assess the extent of fi brosis or scarring of the liver) and to grade disease (quantify the extent and type of liver injury present). Accordingly the main reasons for performing the liver biopsy include the following:
– establishing and or confirming the clinical diagnosis
– exclude other competing diagnoses based on serological testing
– elucidating the possible causes of liver injury
– estimating the severity and extent of any acute or chronic injury which is important for formulating the prognosis of the liver disease.
– monitoring the effects of treatments
Best results are obtained when the clinical hepatologist is performing it with well- defined questions in mind and following the evidence based indications, as listed in Table 1 .
In a position paper prepared for the by American Association for the Study of Liver Diseases (AASLD) Rockey et al. ( 2009 ) indicate that the liver biopsy has three major roles:
– Diagnostic
– Prognostic
– Therapeutic
We recommend this paper as an excellent guide for clinicians contemplating liver biopsy, primarily because it was written by a Practice Guidelines Committee including clinical hepatologists and pathologists. Furthermore its 34 recommendations are evidence based and numerically graded using the established criteria: Class (benefit versus risk, on a scale from I-the highest, to IV lowest usefulness effectiveness) and Level (strength of certainty, on a scale from A, highest to C, lowest of evidence).
The principal messages of that practice oriented position paper are worth reviewing further since they are important for understanding of the clinical value of the pathology findings in liver biopsies.