Practitioners have seen a number of advancements in the assessment of hepatic disease. Significant improvements in serological testing and genetic screening, and numerous advances in diagnostic imaging, including magnetic resonance imaging and cholangiopancreatography, have improved diagnostic capabilities. These improvements notwithstanding, histological assessment of the liver via biopsy remains important in the diagnosis and follow-up of acute and chronic hepatic disease. The procedure of liver biopsy has not changed greatly in the past 50 years. The physician can choose from assessment with fine needle aspiration techniques with fewer attendant complications but with the limitation of cytology assessment only. Histological assessment with a variety of manually inserted or spring-loaded, gun-driven needles is more often required. Liver biopsies may be obtained blind, ie, by clinical estimation of organ location; by using radiological guidance with computerized tomography or ultrasound; via the transvenous (transjugular/transfemoral) route in patients with contraindications to percutaneous biopsy; or via direct vision, surgically or laparoscopically in certain situations.
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Buckley et al. (2000) studied this question.