Liver biopsy in modern clinical practice: a pediatric point-of-view.
Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives, and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost, and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, noninvasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy.
Department of Pediatrics, Morgan Stanley Children's Hospital of New York, NY, USA.
Nadia
N
Ovchinsky
Roger K
RK
Moreira
Jay H
JH
Lefkowitch
Joel E
JE
Lavine
D001656:Biliary Atresia / Q000473:pathology; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D015209:Cholangitis, Sclerosing / Q000473:pathology; D002779:Cholestasis / Q000473:pathology; D000075202:Contraindications; D003550:Cystic Fibrosis / Q000473:pathology; D005234:Fatty Liver / Q000473:pathology; D006008:Glycogen Storage Disease / Q000473:pathology; D006432:Hemochromatosis / Q000151:congenital / Q000473:pathology; D019694:Hepatitis B, Chronic / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000473:pathology; D019693:Hepatitis, Autoimmune / Q000473:pathology; D006527:Hepatolenticular Degeneration / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000473:pathology; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis / Q000473:pathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology; D016031:Liver Transplantation / Q000473:pathology; D065626:Non-alcoholic Fatty Liver Disease; D019896:alpha 1-Antitrypsin Deficiency / Q000473:pathology