Our Summary

Liver fibrosis, or LF, is the scarring that happens when the liver tries to heal from long-term damage. LF is the final stage of chronic liver disease and is the major factor in determining how a patient will fare in the long term. It is important to measure LF to understand the severity of the disease, monitor the response to treatment, and predict future health outcomes.

Traditionally, LF is measured through a liver biopsy, which is a procedure where a small sample of liver tissue is collected for examination. However, a biopsy is invasive and may not always provide an accurate picture of the liver’s condition if the sample size is too small. Therefore, non-invasive tests (NITs) are now commonly used. NITs can be simple blood tests, combinations of blood tests, or imaging tests. These tests are compared against liver biopsies to check their accuracy, and they are expected to replace biopsies for most patients in the future.

Currently, blood tests and imaging techniques like elastography (which measures the stiffness of liver tissue) are used to estimate LF. Other imaging techniques are still being studied and may be used clinically in the future. As imaging tests become more common, it’s important to understand how LF develops. This understanding can help us interpret the results from imaging tests and apply them effectively.

In this review, the authors provide a brief overview of how LF develops, how LF progresses in different chronic liver diseases, and how liver biopsies are used to assess the severity of LF. They also discuss how imaging tests work and how they relate to LF.

FAQs

  1. What is liver fibrosis and why is it important to quantify it?
  2. What are the limitations of liver biopsy in staging liver fibrosis?
  3. What are non-invasive tests (NITs) and how are they used in the evaluation of chronic liver disease?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver biopsy is to follow all pre-operative instructions provided by the healthcare team, such as fasting before the procedure and stopping certain medications as directed. This will help ensure the biopsy can be performed safely and effectively. Additionally, it is important to discuss any concerns or questions with the healthcare team before the procedure to ensure a clear understanding of what to expect.

Suitable For

Patients who are typically recommended for liver biopsy include those with suspected liver fibrosis or chronic liver disease, as liver biopsy is the gold standard for staging fibrosis and evaluating response to treatment. Patients with conditions such as hepatitis B or C, non-alcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and primary biliary cholangitis may be recommended for liver biopsy to assess the extent of liver damage and fibrosis. Additionally, patients with unexplained liver enzyme abnormalities or suspected liver tumors may also undergo liver biopsy for further evaluation.

Timeline

Before liver biopsy:

  1. Patient presents with symptoms of liver disease or abnormal liver function tests.
  2. Patient undergoes imaging tests such as ultrasound, CT scan, or MRI to evaluate the liver.
  3. Blood tests are performed to assess liver function and to rule out other potential causes of liver disease.
  4. Patient may undergo a liver biopsy if imaging tests and blood tests suggest the presence of liver fibrosis.

After liver biopsy:

  1. Patient is prepared for the liver biopsy procedure, which may involve fasting beforehand.
  2. Local anesthesia is administered to numb the area where the biopsy will be performed.
  3. A needle is inserted into the liver to obtain a small tissue sample for analysis.
  4. The tissue sample is sent to a pathology lab for evaluation to determine the extent of liver fibrosis.
  5. Patient may experience mild discomfort or pain at the biopsy site after the procedure.
  6. Results of the liver biopsy are discussed with the patient by their healthcare provider to determine appropriate treatment and monitoring plans.

What to Ask Your Doctor

  1. What is the specific reason for recommending a liver biopsy in my case?
  2. What information will the liver biopsy provide that cannot be obtained through other non-invasive tests?
  3. What are the potential risks and complications associated with a liver biopsy?
  4. How will the liver biopsy be performed and what can I expect during the procedure?
  5. How long will it take to receive the results of the liver biopsy?
  6. What are the possible outcomes of the liver biopsy results and how will they affect my treatment plan?
  7. Are there any specific instructions or precautions I should follow before and after the liver biopsy?
  8. Will I need to make any changes to my medications or diet before the liver biopsy?
  9. Are there any alternative tests or methods that can be used instead of a liver biopsy?
  10. How often will I need to undergo a liver biopsy in the future to monitor my condition?

Reference

Authors: Venkatesh SK, Torbenson MS. Journal: Abdom Radiol (NY). 2022 Mar;47(3):1032-1052. doi: 10.1007/s00261-021-03396-y. Epub 2022 Jan 12. PMID: 35022806