Needle biopsy of the liver: a review.

Specimens of liver for pathological examination may be obtained during life either by open operation or by one of the various methods of percutaneous needle biopsy. Needle biopsy has an interesting history. First employed by Paul Ehrlich in 1883 (quoted by Frerichs in 1884) in a study of the glycogen content of the diabetic liver, and in 1895 by Lucatello in Italy, it passed into general use in tropical medicine in the diagnosis of hepatic abscesses. In temperate climates the method did not achieve early popularity because of the undoubted risks involved. Just before and during the last war, however, there were many cases of non-fatal hepatitis which stimulated investigators to obtain hepatic material for histological study. Liver biopsy by the needle technique was reintroduced among others by Huard, May, and Joyeux (1935) in France, by Baron (1939) in the United States, by Iversen and Rbholm (1939) in Denmark, by Axenfeld and Brass-1942)X Gerhnany, and by Dible, McMichael, and Sherlocl\(1943) in Britain. The elaboration of the technique, the'clearer definition of indications and contraindications, the introduction of various safer needles, and especially the increase in the number of trained operators, has now resulted in needle biopsy being an accepted procedure in most large general hospitals. Because the method has now become so simple, this does not imply that it is always without risk. Needle biopsy should always be regarded as potentially fatal. Five hundred biopsies may be performed without incident only for the 501st to be complicated by massive intraperitoneal haemorrhage demanding immediate treatment. The patients must therefore be carefully selected and a real indication for it must be present before the biopsy is performed.