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Hépato-Gastro & Oncologie Digestive

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Liver biopsy: Trends in indications Volume 20, issue 6, Juin 2013

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Authors
Centre hospitalier Laënnec, service d’hépato-gastroentérologie et de nutrition, Boulevard Laënnec, 60 100 Creil, France, CHU La Cavale Blanche, service d’hépato-gastroentérologie, 29609 Brest Cedex, France

Liver biopsy (LB) has long been established as an essential tool for the management of liver diseases including diagnosis, prognosis and therapeutic decision. Advances in biology, virology, and imaging techniques have changed its place in the initial diagnostic strategy. The recent availability of non-invasive techniques has dramatically modified disease stage assessment. The impact of LB on the therapeutic management varies according to the etiology of liver disease. In chronic hepatitis C, the wide use of non-invasive methods has dramatically decreased the indication of LB for first-line liver fibrosis assessment. Conversely in chronic hepatitis B, LB is still required in most cases for treatment decisions. LB remains the only mean to differentiate simple steatosis from steatohepatitis in NAFLD and to confirm diagnosis and stage fibrosis in autoimmune hepatitis and acute alcoholic hepatitis before deciding whether corticosteroids are indicated or not. In case of a liver nodule arising in a patient with cirrhosis, LB is not necessary in most cases as diagnosis of hepatocellular carcinoma can be done non-invasively by imaging techniques. Indications of LB are evolving in case of presumed benign nodules.