Definition & Overview
A liver biopsy is a procedure performed to remove a tissue sample from the liver to make or confirm a diagnosis. The procedure is performed on an outpatient basis, but it can also be performed during a surgery.
Who should undergo and expected results
Those who need a liver biopsy are patients who:
- Have abnormal liver blood test results
- Have unexplained jaundice
- Have an enlarged liver, as found on diagnostic scans
- Have abnormal X-ray, ultrasound, or CT scan results involving the liver
- Are suspected of having a disease affecting the liver, such as liver cancer, liver cirrhosis, or hepatitis
- Are suspected of having a liver tumour
- Have a tumour and need to determine whether the tumour is malignant or benign
- Have abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) results
- Are suspected of having other liver conditions, such as Wilson's disease or hemochromatosis
- Are under methotrexate medication
- Have had a liver transplant
- Have been suffering from an ongoing fever with no obvious reason
How the procedure works
A liver biopsy is conducted by inserting a needle between the two lower ribs on the right side of the body. The needle then takes a sample of the liver for analysis.
To ensure that the procedure goes well, patients are advised to take certain steps to prepare for a liver biopsy. Prior to undergoing the procedure, patients should inform their doctors if they are:
- Taking aspirin, NSAIDs, anti-platelet medications, and blood thinners; doctors usually advise patients to stop taking said medications at least one week prior to the scheduled biopsy.
- Taking medications for a heart condition
- Taking herbal supplements
- Allergic to certain medications
- Allergic to anaesthetics
- Pregnant or might be pregnant
- Suffering from pneumonia
During the procedure, the patient will be asked to lie still, and an ultrasound will be used to mark the exact location of the liver. At this point, the patient will be given some sedatives as well as a local anesthetic, applied to the upper abdomen. An incision is then made in this area; it is just a very small incision but one that can accommodate the needle that takes the liver tissue sample. Newer techniques have also been developed, such as laparoscopic biopsy wherein, instead of a needle, a thin lighted tube with an attached camera is inserted through the incision. The camera sends an image of the liver to a monitor it is attached to, and the physician uses the image as a guide while he removes tissue samples from the liver.
A laparoscopic liver biopsy is most effective when different tissue samples are needed for specific liver parts. Another alternative technique is the transvenous biopsy, which is most commonly used for patients who have blood clotting problems. This procedure uses a catheter that is inserted into a vein in other parts of the body, such as the neck; from there, the physician will guide the catheter towards the liver. A biopsy needle is then coursed through the catheter and is guided until a sample is obtained.
The entire procedure takes just 5 minutes, but patients are asked to stay for up to 4 hours in a hospital room for observation. There may be some pain or discomfort in the back and shoulders areas, but this is only temporary; patients may talk to their doctor whether a pain medication can be prescribed if the pain is too intense. Patients are also not allowed to drive or operate any machinery within eight hours following the procedure.
Liver biopsy results are usually released several days after the procedure.
Possible risks and complications
Obtaining a liver biopsy is a safe procedure with a very low risk of complications. The only few possible complications that may arise after the procedure are internal bleeding, bile leakage from the gallbladder, and leakage from the liver. These complications, however, are very rare and can easily be avoided by planning and preparing for the liver biopsy.
However, if you experience fever, chills, severe pain in the surgery site, difficulty breathing, dizziness, and pain in the chest, abdomen, or shoulder for 72 hours following the procedure, call your doctor immediately or go to the nearest emergency room.
Lomas DJ. The liver. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 35.
Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:section IX.