Changing indications for liver biopsy: viral hepatitis

Liver biopsy has been an integral part of the management of patients with chronic viral hepatitis. However, several developments have reduced the need for liver biopsy in these patients. Serum based and radiologic non-invasive methods of assessing fibrosis can distinguish between limited and advanced fibrosis and diagnose cirrhosis in these patients. In chronic active hepatitis B infection, antiviral therapy can often be initiated without a liver biopsy as the benefit of treatment extends across all stages of fibrosis. However, the difficulty of determining disease activity and fibrosis by serologic and biochemical data in chronic hepatitis B makes liver biopsy an important tool in the management of a subset of patients. The remarkable progress that has been made in the treatment of hepatitis C is poised to make liver biopsy unnecessary in a large number of patients who previously were treated based on the stage of disease as determined by biopsy. Together, these trends are altering the landscape of liver biopsy in chronic viral hepatitis.