Yunus Emre DALKILIC, Yavuz Emre PARLAR, Cem SIMSEK, Zehranur KIKI, Osman DAG, Cenk SOKMENSUER, Hatice Yasemin BALABAN
Hepatology Forum - 2026;7(3):262-268
Background and Aim: Despite advances in non-invasive methods, liver biopsy remains essential for diagnosis, prognosis, and treatment planning, and this study aimed to evaluate trends in its indications and pathological findings. Materials and Methods: A total of 1533 adult liver biopsies at a tertiary referral hospital (2000-2022) were retrospectively reviewed for indications and diagnoses. Results: The annual number of liver biopsies performed remained stable over the last two decades (730 vs. 803; p=0.06). The mean patient age was 43+/-15 years, with 52% being female. The leading indications were abnormal liver function tests (53.4%), fibrosis/cirrhosis (40.9%), treatment follow-up (2.7%), hepatomegaly (1.6%), and fever of unknown origin (0.9%). Between 2000-2011 and 2012-2022, the indications for liver biopsy changed significantly: biopsies for fibrosis/cirrhosis increased, whereas those for evaluation of treatment response and disease monitoring and for hepatomegaly decreased (p=0.01, p<0.001, and p=0.02, respectively). In the post-COVID-19 period, abnormal liver function tests became the predominant indication (42.2% vs. 69.2%), whereas fibrosis/cirrhosis decreased (54.2% vs. 28%). The most frequent pathological diagnosis was chronic hepatitis B virus (HBV) infection (38.6%), followed by chronic hepatitis C virus (HCV) (11.5%), metabolic dysfunction-associated steatohepatitis (MASH) (8.5%), autoimmune hepatitis (AIH) (7.7%), and primary biliary cholangitis (PBC) (4.2%). Across decades, MASH (6.4% vs. 10.3%; p=0.008), AIH (4% vs. 11.1%), and PBC (1.1% vs. 7%) increased significantly (p<0.001), while chronic HCV declined (17.3% vs. 6.1%; p<0.001). Chronic HBV remained stable (38.2% vs. 38.9%). Conclusion: Over the past 22 years, the annual number of liver biopsies remained stable, with abnormal liver function tests as the leading indication, a decline in fibrosis/cirrhosis evaluation, chronic hepatitis B as the most common diagnosis, and a gradual rise in autoimmune liver diseases and MASH.
