Survival Guide To Liver Biopsies

Kiyoko Oshima, MD, Dr. Sc.

Lysandra Voltaggio, MD

Liver pathology requires patience and attention to detail. While a thorough microscopic examination is necessary, it is not enough, and evaluation of biopsies in a vacuum can be dangerous. Knowledge of the clinical picture including laboratory and imaging studies is imperative. Without such knowledge, pathologists cannot issue a clinically useful report to guide a patient’s diagnosis and treatment. As a result, liver pathology is one of the most intricate subspecialties, and pathologists starting may understandably feel overwhelmed. With this Survival Guide to Liver Biopsies, we provide the reader with a solid, basic foundation of liver pathology. Our goal is to reduce the initial anxiety and guide pathologists to reach correct diagnoses and build on this basic knowledge. 

The first three chapters are dedicated to basic principles and terminology. Recognizing basic features is key to developing robust diagnostic skills. We highly recommend reading these chapters before learning about individual diseases. Familiarization with terminology and key descriptive histological findings is crucial to providing accurate diagnoses. Microscopic descriptions are helpful for beginners (See Chapter 2) and to ensure assessment of all the structures. Do not forget that more than one disease may be present on a given liver biopsy. Chapters four, five, and six cover the most common liver diseases and include practical tips, pitfalls, and ways to work through difficult dilemmas. 

Though diagnostic struggles are common, they often turn into satisfying rewards each time we are able to piece the puzzle together. This book will pave the way to practicing liver pathology.