Acute and chronic hepatitis – why biopsies are still valuable

Abstract

The increasing use of noninvasive methods for assessing liver fibrosis, coupled with the expanding utilisation of direct acting antiviral medications for the treatment of chronic HCV hepatitis, has clearly led to a recent significant decrease in the volume of liver biopsies in daily practice. Nevertheless, histologic assessment of a liver biopsy specimen remains the gold standard for diagnosis of most medical liver diseases. There has been a significant expansion of the clinically important bacterial, fungal, parasitic and viral infections of the liver that must be considered in an era of ever increasing global travel. One of the increasingly common and important indications for liver biopsy is the assessment for possible drug induced liver injury. As biologic agents are utilised more frequently to treat advanced malignancies, clinically significant hepatic toxicity has become a critical limiting factor in their use. The number of new medications of all types is seemingly rising every year, resulting in an ever expanding spectrum of histologic features of drug induced injury. The enormous differential diagnosis for the histologic patterns of acute and chronic hepatitis now faced by the surgical pathologist requires a systematic approach for liver biopsy diagnosis.