Liver biopsy

Liver biopsy — is a procedure for taking a small piece of liver tissue for further microscopic examination. It is the «gold standard» in the diagnosis of many liver diseases, as it allows not only to establish an accurate diagnosis, but also to assess the degree of organ damage (fibrosis) and the activity of the inflammatory process (steatosis, hepatitis).

Research objective: The analysis is performed to obtain an objective picture of structural changes that cannot be fully assessed with blood tests or ultrasound alone. This is critically important for choosing a treatment regimen for viral hepatitis, autoimmune disorders, or storage diseases.

What does the pathologist evaluate:

• Degree of fibrosis: METAVIR score (F0 to F4/cirrhosis), which shows the amount of connective tissue.

• Histological activity index: severity of inflammation and necrosis of liver cells.

• Presence of steatosis: the volume of fat deposits in hepatocytes in nonalcoholic fatty liver disease.

• Specific inclusions: looking for signs of iron overload (hemochromatosis), copper (Wilson's disease), or specific viral markers.

• Atypical cells: differentiation of benign nodules from hepatocellular carcinoma or metastases.

Clinical significance: For gastroenterologists and hepatologists, biopsy results are the foundation for decision-making: from prescribing antiviral therapy to placing a patient on a waiting list for transplantation. The study helps to distinguish toxic liver damage from autoimmune processes, which radically changes treatment tactics.

When is it prescribed:

• chronic viral hepatitis B and C to assess the need for therapy;

• liver enlargement (hepatomegaly) of unknown origin;

• stably elevated liver enzyme levels (ALT, AST);

• suspected cirrhosis, steatohepatitis, or autoimmune hepatitis;

• detection of focal lesions according to MRI or CT data.