The evolving role of liver biopsy: Current applications and future prospects

Abstract

Histopathologic evaluation of liver biopsy has played a longstanding role in the diagnosis and management of liver disease. However, the utility of liver biopsy has been questioned by some, given the improved imaging modalities, increased availability of noninvasive serologic tests, and development of artificial intelligence over the past several years. In this review, we discuss the current and future role of liver biopsy in both non-neoplastic and neoplastic liver diseases in the era of improved noninvasive laboratory, radiologic, and digital technologies.

FIGURE 1

(A) Macrovesicular steatosis (long arrow) and ballooning degeneration of hepatocytes (short arrow) in metabolic dysfunction–associated steatohepatitis (H&E; ×20). (B) Pericellular fibrosis (arrow) in metabolic dysfunction–associated steatohepatitis (Masson Trichome; ×20). (C) Plasma cell-rich portal chronic inflammatory infiltrate (short arrow) with interface hepatitis in autoimmune hepatitis (long arrow) (H&E; ×20). (D) Florid duct lesion (arrow) in primary biliary cholangitis (H&E; ×20). (E) Bile duct injury in hepatic graft-versus-host disease (H&E; ×40). (F) Prominent bile ductular reaction (long arrow) and unpaired artery (short arrow) in focal nodular hyperplasia (H&E; ×20). (G) Focal nodular hyperplasia with “map-like” glutamine synthetase immunohistochemical staining (×20). (H) Inflammatory-type hepatic adenoma with thick-walled artery (long arrow) and sinusoidal dilatation (short arrow) (H&E; ×20). (I) Positive C-reactive protein immunohistochemical stain in inflammatory-type hepatic adenoma (×20). (J) HCC (long arrow); background liver (short arrow) (H&E; ×20). (K) Loss of reticulin staining in HCC (long arrow); intact reticulin staining in background liver (short arrow) (reticulin; ×20). (L) Cholangiocarcinoma, small duct type (H&E; ×20). Abbreviation: H&E, Hematoxylin and Eosin.

FIGURE 1

(A) Macrovesicular steatosis (long arrow) and ballooning degeneration of hepatocytes (short arrow) in metabolic dysfunction–associated steatohepatitis (H&E; ×20). (B) Pericellular fibrosis (arrow) in metabolic dysfunction–associated steatohepatitis (Masson Trichome; ×20). (C) Plasma cell-rich portal chronic inflammatory infiltrate (short arrow) with interface hepatitis in autoimmune hepatitis (long arrow) (H&E; ×20). (D) Florid duct lesion (arrow) in primary biliary cholangitis (H&E; ×20). (E) Bile duct injury in hepatic graft-versus-host disease (H&E; ×40). (F) Prominent bile ductular reaction (long arrow) and unpaired artery (short arrow) in focal nodular hyperplasia (H&E; ×20). (G) Focal nodular hyperplasia with “map-like” glutamine synthetase immunohistochemical staining (×20). (H) Inflammatory-type hepatic adenoma with thick-walled artery (long arrow) and sinusoidal dilatation (short arrow) (H&E; ×20). (I) Positive C-reactive protein immunohistochemical stain in inflammatory-type hepatic adenoma (×20). (J) HCC (long arrow); background liver (short arrow) (H&E; ×20). (K) Loss of reticulin staining in HCC (long arrow); intact reticulin staining in background liver (short arrow) (reticulin; ×20). (L) Cholangiocarcinoma, small duct type (H&E; ×20). Abbreviation: H&E, Hematoxylin and Eosin.