Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2024; 30(14): 1949-1957
Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.1949
Liver biopsy in the post-hepatitis C virus era in Japan
Yoshihiro Ikura, Takako Okubo, Yasuhiro Sakai
Yoshihiro Ikura, Takako Okubo, Department of Pathology, Takatsuki General Hospital, Takatsuki 569-1192, Osaka Prefecture, Japan
Yasuhiro Sakai, Department of Pathology, Kansai Medical University Medical Center, Moriguchi 570-8507, Japan
Author contributions: Ikura Y contributed to the conception and drafting of the manuscript; Ikura Y, Okubo T, and Sakai Y contributed to critical revisions of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yoshihiro Ikura, DSc, MD, Chief Doctor, Professor, Department of Pathology, Takatsuki General Hospital, 1-3-13, Kosobecho, Takatsuki 569-1192, Osaka Prefecture, Japan. ikura@ajk.takatsuki-hp.or.jp
Received: December 26, 2023
Peer-review started: December 26, 2023
First decision: January 24, 2024
Revised: February 5, 2024
Accepted: March 25, 2024
Article in press: March 25, 2024
Published online: April 14, 2024
Processing time: 108 Days and 9.8 Hours
Abstract

In Japan, liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus (HCV) and diagnosing HCV-related hepatocellular carcinoma (HCC). However, due to the development of effective antiviral treatments and advanced imaging, the necessity for biopsies has significantly decreased. This change has resulted in fewer chances for diagnosing liver disease, causing many general pathologists to feel less confident in making liver biopsy diagnoses. This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan. First, it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence. Second, it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions, because clinically diagnosable HCCs are not targets for biopsy. Third, the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs. In conclusion, pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.

Keywords: Liver biopsy; Alteration; Post-hepatitis C virus era; Steatotic liver disease; Hepatic tumors; Immune checkpoint inhibitors

Core Tip: Over the past 30 years in Japan, liver biopsies for assessing hepatitis C virus (HCV) hepatitis and HCV-related liver cancer were common but declined due to advanced treatments and imaging. This shift decreased diagnostic opportunities and eroded general pathologists’ confidence in conducting liver biopsies. This editorial outlines key challenges: Understanding steatotic liver diseases as independent conditions, caution in diagnosing nodular lesions to prevent misinterpretation, and addressing hepatic injuries caused by immune checkpoint inhibitors. It stresses the need for pathologists to adapt to evolving liver disease landscapes and approach biopsies meticulously.