[1] Direct biopsy of tumors of the liver may aid the diagnosis, although this may be avoided if the source is clear (e.g. spread from previously known colorectal cancer).

[1] Occasionally, liver biopsy is required to monitor the progress of treatment, such as in chronic viral hepatitis.

Consensus conference statements recommended liver biopsy in the management of almost all patients with hepatitis C and B.

In 2002, the consensus conferences in France and in the USA raised the possibility of treating patients with chronic hepatitis without liver biopsy.

[7] Approximately 2–3% of patients undergoing liver biopsy require hospitalization for the management of an adverse event.

The sample is examined by microscope, and may be processed further by immunohistochemistry, determination of iron and copper content, and microbiological culture if tuberculosis is suspected[15] For a percutaneous biopsy, it is recommended to use a Birmingham gauge 16 or wider cutting needle, and obtaining a length of 20–25 mm of liver tissue.

The presence of 10–12 portal tracts within the specimen is considered sufficient for reliable analysis, ensuring that architectural relationships between structures are maintained.

[16] Liver biopsy results are limited by sampling error,[10] as abnormal findings may be missed if only normal tissue is retrieved.

The best of these were the perfused hepatic mass (PHM) by quantitative laparoscopic liver spleen scan (QLSS) and oral Cholate clearance and shunt, a blood test.

[20] In 2007 FibroTest was validated by French Health Authorities as a first-line diagnosis of liver injury before biopsy.

[23] Hepascore is a blood test developed in Australia combining the following clinical and laboratory variables: age, gender, bilirubin, GGT, hyaluronic acid, alpha 2 macroglobin to create a score.

[26] APRI (AST to platelet ratio index) is a quick serum biomarker for fibrosis assessment from Italy.