What is the role of liver biopsy and histopathologic exam in the diagnosis of fatty liver disease?

Updated: Apr 12, 2018
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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Liver biopsy and histopathologic examination are important components of the diagnostic evaluation in patients with suspected alcoholic liver disease (ALD). They are the most sensitive and specific means of evaluating the degree of liver cell injury and hepatic fibrosis. Several reasons justify obtaining a liver biopsy in patients with ALD, including the following:

  • Confirming the diagnosis

  • Excluding other unsuspected causes of liver disease

  • Assessing the extent of liver damage

  • Defining the prognosis

In making the decision on whether to perform a biopsy, it is important to consider the strength of the clinical diagnosis and the role that the biopsy findings would have in guiding therapeutic options. For patients who are unlikely to receive specific treatments or who have conditions that make a biopsy unsafe, the 2018 ALD guideline recommends including procedure risk in the biopsy decision. [89]

A liver biopsy and histopathologic examination are required to establish the diagnosis of nonalcoholic fatty liver disease (NAFLD). The diagnosis should be considered in all patients with unexplained elevations in serum aminotransferases (eg, with findings negative for viral markers or autoantibodies or with no history of alcohol use). It should also be considered in patients with NAFLD who are at increased risk of having steatohepatitis and/or advanced fibrosis. [89] The Brunt classification is the standard used to report NAFLD and nonalcoholic steatohepatitis (NASH) biopsy specimens. [36]

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