The pediatric medical liver biopsy: indications, procedures, and histopathology

Investigative work in pediatric liver disease is rapidly growing. Despite noninvasive methods in place for several years, the medical liver biopsy is still a critical step for diagnosing and treating pediatric patients. We provide a narrative review focusing on indications, procedures, and histopathology of pediatric liver biopsy.
We searched the PubMed, Scopus, and Cochrane databases for articles on pediatric liver biopsy, discussing the clinical implications of several procedures and their associated costs. We also complemented our search by digging into the gray literature (e.g., reports, abstracts, textbooks, and Google Scholar) for similar items. The search for articles was conducted between 1 January 2022, and 31 July 2025.
Pediatric liver biopsy is not limited to data gathered following formalin-fixation and paraffin-embedded liver tissue. It includes frozen tissue-based special stains, such as the oil red-O stain for lipids; a specimen devoted to ultrastructural analysis using a transmission electron microscope; and a flash-frozen tissue specimen used for future transcriptomics and genomic studies (e.g., single-nucleotide polymorphisms).