Review ArticlesLiver Biopsy in Modern Clinical Practice A Pediatric Point-of-ViewOvchinsky, Nadia MD, MBA; Moreira, Roger K. MD; Lefkowitch, Jay H. MD; Lavine, Joel E. MD, PhDAuthor Information Departments of *Pediatrics, Morgan Stanley Children’s Hospital of New York †Pathology and Cell Biology, Columbia University College, New York, NY The authors have no funding or conflicts of interest to disclose. Reprints: Joel E. Lavine, MD, PhD, Department of Pediatrics, Columbia University, Morgan Stanley Children’s Hospital of New York, 3959 Broadway, CHN 7, New York, NY 10032 (e-mail: [email protected]). All figures can be viewed online in color at http://http://www.anatomicpathology.com. Advances In Anatomic Pathology: July 2012 - Volume 19 - Issue 4 - p 250-262 doi: 10.1097/PAP.0b013e31825c6a20 Buy Metrics Abstract Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives, and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost, and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, noninvasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy. Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.