Skip to main content

Advertisement

Log in

Liver Biopsy in Children

  • Rational Diagnostics
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Liver biopsy is the cornerstone of medical decision-making for a wide range of hepatic diseases in children. The indications for liver biopsy vary greatly depending on the ease of diagnosis with non-invasive tests, the need to stage of disease, and the role of histological evaluation in management of liver disease. Multiple methods of liver biopsy are available to the clinician and are utilized based on clinical circumstances, cost, and consideration of contraindications. Collaboration between the clinician and pathologist is important in order to handle the tissue sample appropriately and interpret the histology. The purpose of this paper is to provide a broad overview of liver biopsy indications, techniques, pre- and post-biopsy care and complications, interpretations, contraindications, recent advancements, and pitfalls that occur with liver biopsies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Nio M, Wada M, Sasaki H, Tanaka H. Effects of age at Kasai portoenterostomy on the surgical outcome: a review of the literature. Surg Today. 2015;45:813–8.

    PubMed  Google Scholar 

  2. Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, et al. Guideline for the evaluation of cholestatic jaundice in infants: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatric Gastroenterol Nut. 2017;64:154–68.

    CAS  Google Scholar 

  3. Matthai J, Paul S. Evaluation of cholestatic jaundice in young infants. Indian Pediatr. 2001;38:893–8.

    CAS  PubMed  Google Scholar 

  4. Nayak NC, Vasdev N. Neonatal cholestasis syndrome: Identifying the disease from liver biopsy. Indian Pediatr. 2002;39:421–5.

    CAS  PubMed  Google Scholar 

  5. Yang JG, Ma DQ, Peng Y, Song L, Li CL. Comparison of different diagnostic methods for differentiating biliary atresia from idiopathic neonatal hepatitis. Clin Imaging. 2009;33:439–46.

    PubMed  Google Scholar 

  6. Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, et al. Epidemiology of childhood overweight and obesity in India: A systematic review. Indian J Med Res. 2016;143:160–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Schwimmer JB. Clinical advances in pediatric nonalcoholic fatty liver disease. Hepatology. 2016;63:1718–25.

    PubMed  PubMed Central  Google Scholar 

  8. Alkhouri N, Sedki E, Alisi A, Lopez R, Pinzani M, Feldstein AE, et al. Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease. Liver Int. 2013;33:79–85.

    PubMed  Google Scholar 

  9. Bartlett JA, Sanchez LG, Kabbany MN, Shah J, Mittal N, Alkhouri N, et al. The use of liver biopsy to determine the severity of nonalcoholic fatty liver disease in children across the United States. Proceedings of the NASPGHAN Annual Meeting; 2019 October 17–19, Chicago, IL. J Pediatr Gastroenterol Nutr. 2019;69: S1–437.

    Google Scholar 

  10. Ascher Bartlett J.M., Mittal N, et al. A Single Center Assessment of the 2017 NASPGHAN guidelines regarding liver biopsy in the diagnosis of NASH in pediatric patients. Proceedings of the NASPGHAN Annual Meeting; October 24–27, 2018, Hollywood, Fl.

  11. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the study of liver diseases. Liver biopsy. Hepatology. 2009;49:1017–44.

    PubMed  Google Scholar 

  12. Ekstedt M, Franzen LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44:865–73.

    CAS  PubMed  Google Scholar 

  13. Campbell MS, Reddy KR. Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther. 2004;20:249–59.

    CAS  PubMed  Google Scholar 

  14. Pokorska-Spiewak M, Kowalik-Mikolajewska B, Aniszewska M, Pluta M, Marczynska M. Is liver biopsy still needed in children with chronic viral hepatitis? World J Gastroenterol. 2015;21:12141–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Schwarz KB, Rosenthal P, Murrary KF, Honegger JR, Hardikar W, Mittal N, et al. Ledipasvir-Sofosbuvir for 12 Weeks in Children 3 to <6 Years Old With Chronic Hepatitis C. Hepatology. 2020;71:422–30.

    CAS  PubMed  Google Scholar 

  16. Mieli-Vergani G, Heller S, Jara P, Vergani D, Chang MH, Fujisawa T, et al. Autoimmune hepatitis. J Pediatr Gastroenterol Nutr. 2009;49:158–64.

    CAS  PubMed  Google Scholar 

  17. Haas JE, Feusner JH, Finegold MJ. Small cell undifferentiated histology in hepatoblastoma may be unfavorable. Cancer. 2001;92:3130–4.

    CAS  PubMed  Google Scholar 

  18. Verma S, Gunuwan B, Mendler M, Govindrajan S, Redeker A. Factors predicting relapse and poor outcome in type I autoimmune hepatitis: Role of cirrhosis development, patterns of transaminases during remission and plasma cell activity in the liver biopsy. Am J Gastroenterol. 2004;99:1510–6.

    Google Scholar 

  19. Sokal EM, Paganelli M, Wirth S, Socha P, Vajro P, Lacaille F, et al. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: Consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol. 2013;59:814–29.

    PubMed  Google Scholar 

  20. Hom X, Little NR, Gardner SD, Jonas MM. Predictors of virologic response to Lamivudine treatment in children with chronic hepatitis B infection. Pediatr Infect Dis J. 2004;23:441–5.

    PubMed  Google Scholar 

  21. Jara P, Bortolotti F. Interferon-alpha treatment of chronic hepatitis B in childhood: a consensus advice based on experience in European children. J Pediatr Gastroenterol Nutr. 1999;29:163–70.

    CAS  PubMed  Google Scholar 

  22. Chapin CA, Mohammad S, Bass LM, Taylor SA, Kelly S, Alonso EM. Liver biopsy can be safely performed in pediatric acute liver failure to aid in diagnosis and management. J Pediatr Gastroenterol Nutr. 2018;67:441–5.

    PubMed  Google Scholar 

  23. Pasha T, Gabriel S, Therneau T, Dickson ER, Lindor KD. Cost-effectiveness of ultrasound-guided liver biopsy. Hepatology. 1998;27:1220–6.

    CAS  PubMed  Google Scholar 

  24. Mogahed EA, Mansy YA, Al Hawi Y, El-Sayed R, El-Raziky M, El-Karaksy H. Blind percutaneous liver biopsy in infants and children: Comparison of safety and efficacy of percussion technique and ultrasound assisted technique. Arab J Gastroenterol. 2016;17:168–75.

    PubMed  Google Scholar 

  25. Kader HA, Bellah R, Maller ES, Mamula P, Piccoli DA, Markowitz JE. The utility of ultrasound site selection for pediatric percutaneous liver biopsy. J Pediatr Gastroenterol Nutr. 2003;36:364–7.

    PubMed  Google Scholar 

  26. Sherman KE, Goodman ZD, Sullivan ST, Faris-Young S, Group GS. Liver biopsy in cirrhotic patients. Am J Gastroenterol. 2007;102:789–93.

    PubMed  Google Scholar 

  27. Yoshimatsu R, Yamagami T, Tanaka O, Miura H, Tanaka T, Suzuki T, et al. Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance. Br J Radiol. 2012;85:208–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Lindor KD, Bru C, Jorgensen RA, Rakela J, Bordas JM, Gross JB, et al. The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology. 1996;23:1079–83.

    CAS  PubMed  Google Scholar 

  29. Garcia-Compean D, Cortes C. Transjugular liver biopsy. An update. Ann Hepatol. 2004;3:100–3.

    PubMed  Google Scholar 

  30. Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, et al. Transjugular liver biopsy: how good is it for accurate histological interpretation? Gut. 2006;55:1789–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Srivastava A, Prasad D, Panda I, Yadav R, Jain M, Sarma MS, et al. Transjugular Versus Percutaneous Liver Biopsy in Children: Indication, Success, Yield, and Complications. J Pediatr Gastroenterol Nutr. 2020;70:417–22.

    CAS  PubMed  Google Scholar 

  32. Vajro P, Hadchouel P, Hadchouel M, Bernard O, Alagille D. Incidence of cirrhosis in children with chronic hepatitis. J Pediatr. 1990;117:392–6.

    CAS  PubMed  Google Scholar 

  33. Dezsofi A, Baumann U, Dhawan A, Durmaz O, Fischler B, Hadzic N, et al. Liver biopsy in children: Position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2015;60:408–20.

    PubMed  Google Scholar 

  34. Matos H, Noruegas MJ, Goncalves I, Sanches C. Effectiveness and safety of ultrasound-guided percutaneous liver biopsy in children. Pediatr Radiol. 2012;42:1322–5.

    PubMed  Google Scholar 

  35. Kozlovich SY, Sochet AA, Son S, Wilsey MJ. Same-day versus overnight observation after outpatient pediatric percutaneous liver biopsy: A retrospective cohort study. Pediatr Gastroenterol Hepatol Nutr. 2019;22:377–86.

    PubMed  PubMed Central  Google Scholar 

  36. Almeida P, Schreiber RA, Liang J, Mujawar Q, Guttman OR. Clinical characteristics and complications of pediatric liver biopsy: A single centre experience. Ann Hepatol. 2017;16:797–801.

    PubMed  Google Scholar 

  37. Cohen MB, HH AK, Lambers D, Heubi JE. Complications of percutaneous liver biopsy in children. Gastroenterology. 1992;102:629–32.

    CAS  PubMed  Google Scholar 

  38. Westheim BH, Ostensen AB, Aagenaes I, Sanengen T, Almaas R. Evaluation of risk factors for bleeding after liver biopsy in children. J Pediatr Gastroenterol Nutr. 2012;55:82–7.

    PubMed  Google Scholar 

  39. Tulin-Silver S, Obi C, Kothary N, Lungren MP. Comparison of transjugular liver biopsy and percutaneous liver biopsy with tract embolization in pediatric patients. J Pediatr Gastroenterol Nutr. 2018;67:180–4.

    PubMed  Google Scholar 

  40. Ovchinsky N, Moreira RK, Lefkowitch JH, Lavine JE. Liver biopsy in modern clinical practice: a pediatric point-of-view. Adv Anat Pathol. 2012;19:250–62.

    PubMed  PubMed Central  Google Scholar 

  41. Bolia R, Matta J, Malik R, Hardikar W. Outpatient liver biopsy in children: safety, feasibility, and economic impact. J Pediatr Gastroenterol Nutr. 2017;65:86–8.

    PubMed  Google Scholar 

  42. Crawford AR, Lin XZ, Crawford JM. The normal adult human liver biopsy: A quantitative reference standard. Hepatology. 1998;28:323–31.

    CAS  PubMed  Google Scholar 

  43. Bilreiro C, Noruegas MJ, Goncalves I, Moreira A. Ultrasound-guided liver biopsies in children: A singlecenter experience and risk factors for minor bleeding. J Pediatr Gastroenterol Nutr. 2017;65:137–40.

    PubMed  Google Scholar 

  44. Bejarano PA, Koehler A, Sherman KE. Second opinion pathology in liver biopsy interpretation. Am J Gastroenterol. 2001;96:3158–64.

    CAS  PubMed  Google Scholar 

  45. Poddar U, Shava U, Yachha SK, Agarwal J, Kumar S, Baijal SS, et al. Beta-blocker therapy ameliorates hypersplenism due to portal hypertension in children. Hepatol Int. 2015;9:447–53.

    PubMed  Google Scholar 

  46. Xu H, Cai R. Avatrombopag for the treatment of thrombocytopenia in patients with chronic liver disease. Expert Rev Clin Pharmacol. 2019;12:859–65.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Naveen Mittal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rabbani, T., Ascher Bartlett, J.M. & Mittal, N. Liver Biopsy in Children. Indian Pediatr 57, 734–740 (2020). https://doi.org/10.1007/s13312-020-1918-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-020-1918-3

Keywords

Navigation