Home « Diagnosis « Liver Biopsy

Liver biopsy provides direct information about the structure, function, and extent of iron deposition within the liver, and may also have prognostic value.

Advantages of liver biopsy

Liver biopsy provides the most quantitatively accurate, sensitive, and specific test for liver iron concentration (LIC), and can be used to accurately estimate body iron burden. The test also allows for direct evaluation of non-heme liver storage iron, as well as histochemical examination of differential accumulation in hepatocytes and Kupffer cells. The test also provides insight into liver tissue histology and pathology through assessments of inflammation, fibrosis, and cirrhosis. Liver biopsy is the method of choice in the research community for assessing total body iron.

Disadvantages of liver biopsy

Liver biopsy is an invasive and painful procedure, and carries the risk of bleeding and infection, as well as damage to the liver or surrounding organs. Fatal complications have been reported, but these are rare (1,2). The safety of liver biopsy is enhanced by ultrasound guidance; a complication rate of 0.5% was reported in one large study (3). Sampling errors, especially in the cases of cirrhosis or low weight sample sizes, have been reported (4). Liver iron concentration is poorly correlated with cardiac iron deposition.

Heterogeneity of iron distribution in a cirrhotic liver Substantial variability of LIC values seen in a cirrhotic liver. Image used with permission of Yves Deugnier and Bruno Turlin, Liver Unit & Department of Pathology, CHU Pontchaillou, Rennes, France.

Prognostic value of LIC

Studies have demonstrated the prognostic value of liver iron concentration in both transfusional and hereditary iron overload. Patients with thalassemia major who had an LIC above ~ 15 mg Fe/g of liver dry weight (dw) had a higher risk of cardiac complications and early death than those whose LIC was below this threshold,(5) suggesting the clinical value of a "critical LIC" value. Threshold levels for hepatocellular injury(6) and fibrosis or cirrhosis are above LIC levels of approximately 22.0 mg Fe/g dw (7). Critical LIC may also be used to guide iron chelation therapy.

Critical LIC values >15 mg Fe/g dw predict increased risk of cardiac disease (5). Above about 22 mg Fe/g dw, fibrosis or cirrhosis is common (7).

Learn about treatment of iron overload