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What Is a Liver Biopsy?

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Updated August 14, 2008

Liver biopsies are important diagnostic tools for anyone with cancer-like lesions on their liver, which can be caused by a variety of illnesses, including hepatitis and many other liver diseases such as cirrhosis, cancer, sarcoidosis, and amyloidosis. Even though physicians can get a lot of information from blood tests, sometimes there is no substitute for actually seeing what's happening in the liver.

What Is a Liver Biopsy?

During a biopsy, a very small piece of your liver is removed using a special needle. The removed tissue is then studied by a pathologist (a physician-specialist trained in determining disease from laboratory tests) who reports the results to your physician. This test can be done several ways, but the percutaneous method is very common. This is done by sticking a needle through the ribs into the liver. A small piece of liver tissue is sucked into the needle and pulled out. The process is very quick and relatively painless. For people with special concerns, such as those who are high risk of excessive bleeding, the procedure may be done differently.

Who Needs a Biopsy?

Doctors order liver biopsies for many reasons. For people with hepatitis, a biopsy can determine what caused the disease. By looking at the liver tissue microscopically, a physician can see if the damage was caused by viruses or toxins or even a combination of several things. If cirrhosis is present, liver biopsy can determine how advanced the fibrosis is and can assign it a "grade" in order to compare future changes. In fact, liver biopsy is the most accurate way to determine how much cirrhosis your liver has and if disease is early or advanced. Another important reason for liver biopsy is to provide information to determine the best treatment. Mild liver disease may lead your physician to wait on treatment in some people, while advanced liver disease may suggest aggressive treatment.

Who Shouldn't Get a Biopsy?

Although a liver biopsy provides important information, some people will not be able to get one. These people have certain conditions where liver biopsies are not recommended (which are known as contraindications) and doctors must use other tests to get the necessary information. These conditions increase the risk of complications during or after a liver biopsy and will probably prevent you from getting one:
  • Bleeding disorders
  • Vascular liver tumors
  • Ascites
  • Certain chest infections
  • Biliary tract infections

What Are Problems of Biopsy?

Liver biopsy is considered to be a safe medical test. Considering that the information from a liver biopsy is very important to the physician, the risks from the procedure are relatively few. However, as with any minor surgery, there are risks from liver biopsy that you need to understand. Before any procedure, you will discuss these risks with your physician:
  • Bleeding in the liver and around the site of the procedure
  • Pain around the biopsy area
  • Infection
  • Damage to liver tissue
It isn't coincidence that the problems associated with biopsy are similar to the contraindications for biopsy. If you are already experiencing similar problems that can be caused by the procedure, doctors will probably want to avoid giving you a biopsy.

How Is a Biopsy Taken?

To prepare for your liver biopsy, your doctor will schedule the test at the hospital so in case anything goes wrong, additional medical support will be available. You'll probably be asked not to eat or drink anything for about 8 hours before the procedure and your doctor will also probably order blood tests to see if your blood properly clots.

For the test, you'll probably lie on your back and have your right arm positioned above your head. The doctor may want to feel your liver by pressing on your belly just under your rib cage. Once the site is chosen, topical antiseptic will be applied to your skin to reduce the risk of infection. You'll be awake for the entire procedure, but you'll have local anesthetic (usually lidocaine which is the same drug that dentists use to numb your gums) applied to the area. After the site is properly numbed, the doctor will insert the special biopsy needle into the skin between your tenth and eleventh ribs from the side of your body. The goal is to pierce the liver with the needle, low enough to miss your lungs and diaphragm, but high enough to miss the intestines. The needle stick is very quick, and believe it or not, relatively painless.

The actual procedure will go fast (depending on the method, about 20 minutes), but you'll need to stay after the test for several hours so the doctor can monitor your recovery. If no problems are seen, then you'll be able to leave. However, at home you'll probably need to rest and take it easy for one or two days to give your liver time to heal.

Sources:

Berenguer, M and Wright, TL. Hepatitis C. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1693.

Dienstag, JL. Chronic Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

Ghany, M and Hoofnagle, JH. Approach to the Patient with Liver Disease. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

National Digestive Diseases Information Clearinghouse. November 2004. Liver Biopsy.

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