Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 7, 2008; 14(21): 3396-3402
Published online Jun 7, 2008. doi: 10.3748/wjg.14.3396
Why, who and how should perform liver biopsy in chronic liver diseases
Ioan Sporea, Alina Popescu, Roxana Sirli
Ioan Sporea, Alina Popescu, Roxana Sirli, Department of Gastroenterology, University of Medicine and Pharmacy, Timisoara 700736, Romania
Author contributions: Sporea I wrote the paper and revised data from the literature, Popescu A and Sirli R researched for data from the literature and revised the manuscript.
Correspondence to: Ioan Sporea, Department of Gastro-enterology, University of Medicine and Pharmacy, Timisoara 700736, Romania.
Telephone: +40-256-309455
Fax: +40-256-488003
Received: October 19, 2007
Revised: April 12, 2008
Accepted: April 19, 2008
Published online: June 7, 2008

Chronic viral hepatitis is a common disease in the general population. During chronic hepatitis, the prognosis and clinical management are highly dependent on the extent of liver fibrosis. The fibrosis evaluation can be performed by FibroTest (using serological markers), by Elastography or FibroScan (a noninvasive percutaneous technique using the elastic properties of the hepatic tissue) and by liver biopsy (LB), considered to be the “gold standard”. Currently, there are three techniques for performing LB: percutaneous, transjugular and laparoscopic. The percutaneous LB can be performed blind, ultrasound (US) guided or US assisted. There are two main categories of specialists who perform LB: gastroenterologists (hepatologists) and radiologists, and the specialty of the individual who performs the LB determines if the LB is performed under ultrasound guidance or not. There are two types of biopsy needles used for LB: cutting needles (Tru-Cut, Vim-Silverman) and suction needles (Menghini, Klatzkin, Jamshidi). The rate of major complications after percutaneous LB ranges from 0.09% to 2.3%, but the echo-guided percutaneous liver biopsy is a safe method for the diagnosis of chronic diffuse hepatitis (cost-effective as compared to blind biopsy) and the rate of complications seems to be related to the experience of the physician and the type of the needle used (Menghini type needle seems to be safer). Maybe, in a few years we will use non-invasive markers of fibrosis, but at this time, most authorities in the field consider that the LB is useful and necessary for the evaluation of chronic hepatopathies, despite the fact that it is not a perfect test.

Keywords: Chronic hepatitis, Liver biopsy, Fibrosis, Ultrasound guidance