Liver Biopsy Techniques in Chronic Hepatitis Assessment

Liver biopsy remains the reference standard for staging and grading chronic hepatitis, providing direct histological insight into necroinflammation, fibrosis and architectural change. Techniques have evolved from blind, thick‐needle approaches to image‐guided methods that improve yield and safety. Ultrasound or CT guidance allows real‐time visualisation of needle position, reducing sampling error and complication rates. Coaxial systems enable multiple core samples via a single puncture track, limiting tissue disruption. Cutting‐needle designs yield larger specimens for reliable grading, while fine‐needle aspiration may be reserved for focal lesion sampling. Emerging image technologies such as second harmonic generation and two‐photon excitation fluorescence permit quantitative analysis of collagen architecture in small cores. Procedural refinements—choice of gauge, number of passes, tract plugging and standardised post‐procedure observation periods—have collectively reduced bleeding, pain and rare but serious events. Despite the advent of non‐invasive surrogates for fibrosis, biopsy continues to guide therapeutic decisions in equivocal cases, inform novel biomarker validation and underpin clinical trials by delivering tissue for molecular profiling.

Research from Nature Portfolio

A retrospective evaluation of computed tomography‐guided core biopsies using a coaxial technique assessed the impact of biopsy tract plugging with gelatin sponge slurry on haemorrhagic risk. In over 300 procedures, tract plugging was technically successful in all cases and eliminated major bleeding events. Minor bleeding rates remained low and comparable between plugged and unplugged groups. Statistical analysis highlighted a correlation between the number of needle passes and both minor and overall bleeding, supporting strategies to limit passes while securing adequate diagnostic material.

Liver Biopsy Techniques in Chronic Hepatitis Assessment publication trend

The graph below shows the total number of articles in liver biopsy techniques in chronic hepatitis assessment across all publications each year (not limited to Nature Index journals).

Technical terms

Percutaneous biopsy: Minimally invasive collection of liver tissue via a needle inserted through the skin under imaging guidance.

Coaxial technique: Use of an outer introducer needle that permits multiple core samples with a single puncture, reducing parenchymal disruption.

Biopsy tract plugging: Insertion of absorbable material (e.g. gelatin sponge) into the needle track post-sampling to prevent bleeding.

Second harmonic generation (SHG): A nonlinear optical imaging modality sensitive to fibrillar collagen, used for quantitative fibrosis assessment.

Two-photon excitation fluorescence (TPEF): An imaging technique that excites tissue fluorophores via simultaneous absorption of two photons, enabling deeper, high-resolution visualisation of extracellular matrix in small biopsy cores.

References

1. Medical liver biopsy: background, indications, procedure and histopathology. Frontline Gastroenterology (2019).
2. Bleeding management in computed tomography-guided liver biopsies by biopsy tract plugging with gelatin sponge slurry. Scientific Reports (2021).
3. Comparison of a coaxial versus non-coaxial liver biopsy technique in an oncological setting: diagnostic yield, complications and seeding risk. European Radiology (2020).
4. SHG/TPEF-based image technology improves liver fibrosis assessment of minimally sized needle biopsies. Hepatology International (2019).
5. One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project. Cureus (2019).