AASLD develops evidence-based practice guidelines and practice guidances which are updated regularly by a multi-disciplinary panel of experts, including hepatologists, and include recommendations of preferred approaches to the diagnostic, therapeutic, and preventive aspects of care.
Histological assessment of the liver, and thus, liver biopsy, is a cornerstone in the evaluation and management of patients with liver disease and has long been considered to be an integral component of the clinician’s diagnostic armamentarium. Although sensitive and relatively accurate blood tests used to detect and diagnose liver disease have now become widely available, it is likely that liver biopsy will remain a valuable diagnostic tool. Although histological evaluation of the liver has become important in assessing prognosis and in tailoring treatment, noninvasive techniques (i.e., imaging, blood tests) may replace use of liver histology in this setting, particularly with regard to assessment of the severity of liver fibrosis. Several techniques may be used to obtain liver tissue; a table including/defining specific terms has been provided in an effort to standardize terminology. All liver biopsy techniques require specific training so as to ensure appropriate-sized specimen retrieval and the lowest rate of complications. Although liver biopsy is often essential in the management of patients with liver disease, physicians and patients may find it to be a difficult undertaking because of the associated risks. The purpose of this practice guideline is to summarize the current practice of liver biopsy and make recommendations about its performance. This guideline deals exclusively with liver biopsy as it relates to adult liver disease.