We read the interesting study by Szymczaket al. regarding the safety and effectiveness of a blind percutaneous LIVER BIOPSY, where they concluded that the failure rate and the risk of complications are low if indications and contraindications are carefully considered.Moreover, these authors emphasize how important it is that biopsies are performed by skilled and experienced operators. This study raises controversy, however, as although a LIVER BIOPSY is reasonably safe, it is still an invasive procedure and it is unclear as to whether the histology results affect the management of patients with LIVER disease. In addition, the increasing availability of noninvasive techniques for staging hepatic fibrosis, together with new and advanced radiological, immunological, virological and molecular genetic tests, may undermine the future role of LIVER BIOPSY in clinical practice.

Background: LIVER BIOPSY is the gold standard method for the assessment of LIVER fibrosis and diagnosis of different LIVER diseases. The most common method of LIVER BIOPSY is transdermal BIOPSY, which can be performed under the guidance of ultrasound (US) or blindly. The present study aimed at comparing the success rate and complications of these two methods in patients undergoing LIVER BIOPSY. Materials and Methods: This interventional study was performed on 102 patients, who were candidates for LIVER BIOPSY without any contraindications. The patients were randomly divided in two groups of US-guided BIOPSY and blind BIOPSY. The patients’ demographics, indications for BIOPSY, and complications were collected in a checklist. Data were analyzed using Chi-square test and independent sample t-test in SPSS version 16. Results: Among 102 participants, 51 patients (25 males and 26 females), with the mean age of 39. 69 ± 12. 93 years, underwent US-guided BIOPSY, while 51 patients (29 males and 26 female), with the mean age of 39. 65 ± 13. 73 years, underwent blind BIOPSY. LIVER BIOPSY was successful in 88. 2% of the patients in both groups. The most common complication was reduced hemoglobin level, which was not significantly different between the groups. Other complications, such as need for blood transfusion, platelet transfusion, or fresh frozen plasma (FFP) injection, were not observed. There was no significant difference in terms of complications between the groups. Conclusion: Since blind LIVER BIOPSY does not increase the rate of complications, application of this method is recommended for patients without any contraindications, leading to a reduction in the cost of diagnosis and treatment.

There is now adequate evidence to indicate that LIVER fi­brosis is a dynamic rather than a static process and as effec­tive antiviral and other specific therapies became available, fibrosis and even cirrhosis could become reversible (1, 2). Effective and early therapy of viral and autoimmune hepa­titis could result in reversibility of cirrhosis in addition to clinical cure (1-3). Therefore, we urgently need to be able to follow the progression or regression of fibrosis in response to therapy in addition to initial assessment of fibrosis by LIVER BIOPSY. LIVER BIOPSY which was first introduced in 1923 has been used widely in the diagnosis of LIVER diseases and is still the gold standard reference for the assessment of LIVER fibrosis during the course of chronic LIVER diseases (4, 5)….

Dear Editor: I read with interest the article by Cakmakci et al. published in your journal recently. Although LIVER BIOPSY has been considered as the “gold standard” for defining LIVER disease status, and evaluating the progress of the disease, it is a risky procedure and there are a few limitations that affect the clinical acceptance of the process. Risk of bleeding due to invasiveness of the procedure is one of the factors that affects both patient and clinician tendency to the procedure.

Introduction: LIVER BIOPSY is the gold standard diagnostic modality used in assessment of the underlying cause of LIVER diseases and staging of the degree of fibrosis. It is an invasive procedure and can be associated with complications which may be a deterrent in requesting a BIOPSY. The aim was to evaluate the safety and complication rates of blind and ultrasound-guided LIVER BIOPSY. Methods: Retrospective analysis of patients who underwent LIVER BIOPSY from 2001 to 2005 and from 2014 to 2018. Patients who had a BIOPSY for a LIVER lesion or in the post-transplant setting were excluded. Results: 857 patients were identified; 63% male, with a median age of 44 years (range 15-80). The most common indication for a LIVER BIOPSY was chronic viral hepatitis B and C (56%) followed by LIVER function derangement of unclear aetiology (30%). The two main histological diagnoses were inflammation secondary to viral hepatitis (55%) and non-alcoholic fatty LIVER disease (24%) and 15 % were cirrhotic. 85% (N=728) of biopsies were performed under ultrasound guidance and the remaining 15% (N=129) were blind percutaneous biopsies. Complication rates are shown in the following table: . ..

In recent article which is published in your journal Crisan D et al. has been reported an interesting article about noninvasive assessment of LIVER fibrosis. They evaluated six serum marker panels (APRI, Forns, Fib-4, Hepascore, Fibro Test, Fibro meter) and transient elastography (TE) alone or in combination, for prediction of LIVER fibrosis stages in 446 chronic hepatitis C (CHC) patients. In addition they evaluated whether the combination of serum panels with TE could increase the diagnostic accuracy of LIVER fibrosis assessment or not. The authors concluded that combination of some of previously mentioned serum marker panels with TE, increases the diagnostic accuracy of non-invasive methods for the assessment of LIVER fibrosis stage.

Background: Thalassemia major is the most frequent hereditary anemia in Iran. In this study we wanted to evaluate LIVER status of these patients prior to bone marrow transplantation. Materials and Methods: LIVER biopsies of 108 patients were evaluated for degree of iron deposition, fibrosis and inflammation, along with some clinical and paraclinical data.Results: In all of these patients some degree of iron deposition was found (16 percent had score 3 and 36 percent had score 4 of Marx and Sindram scoring system). Fibrosis was seen in 68 percent of patients, mostly of mild to moderate degree (HAI score: 1 to 4 ) and only 3 patients had severe fibrosis (HAI score: 5 and 6). Inflammation was absent in 30 percent of patients and others had mild to moderate degree of inflammation. Serum ferritin level above 1500 Microgram per liter was strongly related to increased degree of iron load, fibrosis and inflammation. Conclusion: LIVER BIOPSY prior to bone marrow transplantation can be very useful in assessing degree of iron overload, fibrosis and inflammation.Conclusion: LIVER BIOPSY prior to bone marrow transplantation can be very useful in assessing degree iron overload, fibrosis and inflammation.

Backgrounds/Objective: In patients with atypical hemangiomas who have inconclusive imaging features, performing other diagnostic procedures, especially BIOPSY, is indicated. Bleeding is the most feared complication due to the high vascular nature of hemangioma. The objective of this study was to present our experience on ultrasound-guided core needle BIOPSY of LIVER hemangiomas. Patients and Methods: We carried out ultrasound-guided core needle biopsies in 443 patients with focal hepatic lesions of whom 32 were subsequently diagnosed as having cavernous hemangiomas. Biopsies were done using a 16–18 G cutting needle at Mashhad Imam Reza Hospital and Isfahan Baharestan Hospital during 2004–07. Results: The mean age of patients with hemangioma was 49.3 years (F/M = 2/1). The lesions were 0.8–14 (mean: 6.5) cm long. 13 patients had multiple (2–10) lesions; others had solitary lesions with atypical imaging features. We did not observe any complications including hemorrhage during or after the procedure. Conclusion: Ultrasonically-guided core needle BIOPSY seems to be a relatively safe procedure even when "atypical hemangioma" is a diagnostic possibility.

Background: LIVER is prone to different diseases including metabolic, congenital, infections, drug injuries, and malignancies. LIVER BIOPSY is an aggressive but definitive way to diagnose LIVER diseases.Objectives: The present study is designed to evaluate the results of LIVER biopsies in children referred to the Pediatric Gastroenterology Department of Nemazee Hospital.Materials and Methods: The present retrospective study was conducted on 308 LIVER BIOPSY specimens from children suspected to LIVER diseases who had been referred to Pediatric Gastroenterology Department affiliated to Shiraz University of Medical Sciences between March 2003 and March 2008.Results: Totally 308 LIVER biopsies from the children aged less than 18 years was investigated. There were 128 girls and 180 boys with mean age of 6.04±5.97 years and Male/Female ratio of 1.4/1. The most common pathologic findings were chronic hepatitis (n=71; 23.1%), metabolic diseases (n=37; 12.1%), cirrhosis (n=27; 8.8%), secondary hemochromatosis (n=22; 7.1%), neonatal hepatitis (n=22; 7.1%), and hepatic malignancies (n=21; 6.8%). LIVER BIOPSY was non diagnostic in 16.2% (n=50) of the patients.Conclusions: Chronic hepatitis, metabolic LIVER diseases, cirrhosis, and neonatal hepatitis are the most common LIVER diseases in children in our center. In this study a high percentage of LIVER biopsies were non-diagnostic. Therefore, providing the necessary facilities and equipment for special assessment of LIVER tissue are essential in this center.