Hepatobiliary practical: how to get the best out of a liver biopsy

The liver biopsy has a unique place in the investigation of liver disease because the concepts and classification of liver disease are rooted in morphology. Today, the use of the liver biopsy has extended beyond that of diagnosis, to the assessment of disease progression, response to therapy and transplant rejection. To get the best out of the liver biopsy, it is necessary to appreciate the usefulness and limitations of the biopsy specimen. Aspects to consider include: (1) minimizing sampling errors, and appreciating that the changes in the biopsy may not be representative of the primary pathology, (2) good laboratory quality practices to avoid processing artifacts, which may render a biopsy undiagnosable, (3) the appropriate use of special stains and other laboratory techniques, (4) adoption of a systematic and algorithmic approach in the microscopic examination of the biopsy, and (5) good clinicopathological correlation.