Advances in clinical hepatology and what the hepatologist expects from a liver biopsy result

Liver disease is increasing. Traditionally, there have been several main indications for liver biopsy.First, to establish the aetiology of disease, second, to stage disease and third to grade severity of disease in terms of activity to establish prognosis. Biopsy can also be used to monitor progress serially and to diagnose cancers and other focal pathology. Each of these long established uses for liver biopsy is now besieged by new technology.New serological markers and clinical scoring systems, complement biopsy to assist us with diagnosis, in some cases making biopsy unnecessary. Non-invasive markers of liver fibrosis are entering clinical practice and replacing the need for biopsy to stage disease and diagnose cirrhosis.Increasingly the static nature of a biopsy and other point in time measures gives way to measurements that reflect prognosis. As other modalities replace biopsy there is potential for “diagnostic drift” away from the classic pathology of the condition. Despite this, the rising tide of liver disease means that the importance of liver biopsies will not decrease and the nature of questions being asked by the hepatologist are likely to become more difficult.