title: Is liver biopsy still needed in children with chronic viral hepatitis?
abstract: Liver biopsy is a standard method used for obtaining liver tissue for histopathological evaluation. Since reliable serological and virological tests are currently available, liver biopsy is no longer needed for the etiological diagnosis of chronic hepatitis B and C. However, liver histology remains the gold standard as a prognostic tool, providing information about the liver disease progression (grading of necroinflammatory activity and staging of fibrosis) and serving clinicians in the management and therapeutic decisions. In general, histopathological evaluation is indicated before starting the antiviral treatment. Main limitations of the liver biopsy include its invasive and painful procedure, sampling errors and the inter- and intra-observer variability. In addition, indications for the liver biopsy in pediatric patients with chronic viral hepatitis were questioned recently, and efforts have been made toward the development of non-invasive methods as an alternative to the liver biopsy. The most commonly used methods are novel imaging studies (elastography) and combinations of biomarkers. However, to date, none of these tests was validated in children with chronic viral hepatitis. In this review, we present the current status of the liver biopsy in the management of chronic viral hepatitis B and C in pediatric population, including specific indications, complications, contraindications, problems, limitations, and alternative non-invasive methods.
authors.affiliation: Maria Pokorska-Śpiewak, Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Magdalena Marczyńska, Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Pokorska-Śpiewak
authors.affiliation: Maria Pokorska-Śpiewak, Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Magdalena Marczyńska, Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kowalik-Mikołajewska
authors.affiliation: Maria Pokorska-Śpiewak, Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Magdalena Marczyńska, Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Aniszewska
authors.affiliation: Maria Pokorska-Śpiewak, Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Magdalena Marczyńska, Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pluta
authors.affiliation: Maria Pokorska-Śpiewak, Barbara Kowalik-Mikołajewska, Małgorzata Aniszewska, Magdalena Pluta, Magdalena Marczyńska, Department of Children's Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Marczyńska
mesh_terms: D000367:Age Factors; D001706:Biopsy / Q000009:adverse effects; D060085:Coinfection; D019694:Hepatitis B, Chronic / Q000150:complications / Q000473:pathology* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Children; Elastography; Fibrosis; Hepatitis B; Hepatitis C; Liver biopsy; Pathology