Noninvasive Alternatives to Liver Biopsy

Abstract

During the past 60 years the role and importance of liver biopsy have changed. In 1950s the introduction of liver puncture biopsy was absolute innovation, e.g. in Latvia, and had an invaluable significance. The possibility to compare and/or oppose alterations of liver structure and liver function was achieved and it caused the information explosion. The spectrum of morphological research included investigations of liver tissue damage on different levels that explained the mechanisms of biochemically detected cytolysis and cholestasis syndrome, fibrosis and liver cirrhosis development. Relatively, in least degree the morphological phenomena of apoptosis and its role in acute and chronic liver diseases were examined. Frequently conventional liver function tests are limited to quantifying hepatic function. Despite major progress in the diagnostics and therapy of liver diseases of different etiologies, the assessment of liver function continues to present a major clinical problem. Most of liver function tests are not sufficiently specific and do not accurately predict liver failure and outcome of it. Liver biopsy is an essential part of the diagnostics and follow-up of many liver diseases giving clinically important information as well as scientific data. At present, it is the most specific test to assess the nature and severity of liver damage (Bravo et al., 2001). However, the role of liver biopsy in the evolution of medical science is dynamic. It became possible with the development of methods able to bring sufficient amount of liver tissue as well as to ensure the safety of the procedure itself. The methods used to obtain liver tissue include transcutaneous needle biopsy and transvenous approach via jugular or femoral vein. Occasionally, liver can be biopsied during laparoscopy or open abdominal surgery. Aseptics and antiseptics are of importance. There is an obvious necessity to ensure the monitoring of the patient and control of possible albeit rare complications. It seems reasonable to expect further developments in the field of liver morphology that might include both in-depth studies of tissue (Dioguardi et al., 2008) as well as elaboration of novel, completely different diagnostic methods. The indications for liver biopsy include 1) the grading and staging of chronic viral hepatitis, alcohol-related liver damage, non-alcoholic steatohepatitis and autoimmune hepatitis; 2)