What Is a Liver Biopsy? When and How Is It Performed?

What Is a Liver Biopsy?

A liver biopsy is a test that allows doctors to examine a tissue sample taken from the liver under a microscope. It can be used to test for many serious medical conditions, including cancer. Doctors may recommend a liver biopsy if a person has signs of liver disease.

A liver biopsy is not a routine medical test or one that doctors recommend as part of an annual examination. Rather, doctors may request it when they suspect other signs of liver disease, such as abnormal liver blood tests or ultrasound findings suggesting a liver problem (cirrhosis, fibrosis or cancer).

During a liver biopsy, an interventional radiologist inserts a long, thin needle into the liver and removes a small amount of tissue. A pathologist then examines the tissue under a microscope for signs of disease.

Why Is a Liver Biopsy Performed?

A liver biopsy allows doctors to examine liver tissue under a microscope. It therefore helps identify unusual changes in the liver in conditions such as liver disease or liver cancer.

• Related topic: 5 Key Facts About Liver Cancer

A biopsy can also help the specialist distinguish between different possible causes of liver health problems. For example, they may use it to identify nonalcoholic fatty liver disease or autoimmune hepatitis.

What Should You Do Before a Liver Biopsy?

Blood tests are needed before a liver biopsy to assess whether the person has any conditions that increase the risk of bleeding or other complications (a complete blood count, biochemistry and bleeding-time tests such as PT).

People should tell their doctor and healthcare team about any medications or supplements they currently take and continue taking them as usual unless a specialist advises otherwise.

Doctors generally recommend that, 1 week before the biopsy, aspirin, blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) be discontinued. These can increase the risk of bleeding. People may also be instructed not to eat or drink anything after midnight on the night before the procedure.

Sedation may cause grogginess after a liver biopsy, so it is important to bring someone along when having the procedure.

How Is a Liver Biopsy Performed?

There are three different types of liver biopsy:

• Percutaneous liver biopsy
• Transvenous liver biopsy
• Laparoscopic liver biopsy

Percutaneous Liver Biopsy

This is the most commonly performed type of liver biopsy. The person is awake during the procedure, and the specialist inserts a needle through the skin and into the liver to take a tissue sample. The specialist can locate the liver by feeling it beneath the skin or with ultrasound guidance.

Lidocaine (a local anesthetic) is injected into the skin and underlying area around the liver. A small incision is made along the ribs, and the needle is then inserted through it. When the needle enters, the person may be asked to hold their breath briefly.

Most people do not feel pain, but they may experience a dull ache or shoulder pain.

Below, a new-generation percutaneous liver biopsy method is illustrated. Unlike other percutaneous liver biopsies, this method uses an optical needle (which lights up under ultrasound). This allows the intended biopsy area to be targeted more effectively (ONP = optical needle probe).

Transvenous Liver Biopsy

This method is very rarely preferred. In a transvenous liver biopsy, the needle is not inserted directly through the skin into the liver; instead, the liver is reached through a vein. This may reduce the risk of complications in people with certain medical conditions. The person remains conscious but is sedated.

First, the area where the needle will enter the blood vessel is numbed. The needle is then usually inserted into a blood vessel in the neck. Using a fluoroscope to visualize the inside of the body, it is slowly advanced to the liver, and a sample is then taken.

Laparoscopic Liver Biopsy

A laparoscopic liver biopsy is performed in an operating room under general anesthesia. However, it can occasionally be performed as an outpatient procedure with moderate sedation.

A small incision is made in the abdomen, and a liver sample is taken. A laparoscopic liver biopsy may also be performed during another surgical operation. It is a procedure recommended for people with chronic liver disease (cirrhosis).

What Does Having a Liver Biopsy Feel Like?

People are often concerned about pain during a liver biopsy. In most cases, they may feel the needle the specialist uses to numb the biopsy site. No pain is felt, although tingling may occur as the area becomes numb.

People receiving anesthesia during a laparoscopic procedure will not feel anything.

After these procedures, people may experience some soreness or pain, but it will not be severe or unbearable.

What Happens After a Liver Biopsy?

Regardless of the type of liver biopsy performed, the American Association for the Study of Liver Diseases recommends remaining in hospital or under a specialist's supervision for 2 – 4 hours afterward. Most complications occur within the first 1 – 3 hours after the biopsy, but it is important to remember that a complication can also occur within 24 hours.

Anyone who experiences severe pain and feels very weak or unwell after the procedure should consult a specialist. Specialists should also inform people undergoing a liver biopsy about which situations or symptoms afterward constitute an emergency.

What Are the Risks Associated With a Liver Biopsy?

The test is successful in more than 95% of people undergoing a liver biopsy. The overall complication rate is low, at approximately 1%, while the mortality rate is 0.2%.

Nevertheless, a liver biopsy cannot be described as risk-free. People—particularly older adults and those with health problems—should therefore discuss the risks and benefits with a healthcare professional.

The most common complications of liver biopsy include:

• Pain after the procedure in most people
• Bleeding, which is rare in people with cancer (0.57%) and even rarer in those without cancer (0.16%)
• Bacteria in the bloodstream, which usually resolve on their own
• A serious bacterial infection in or around the liver
• Very rare complications, such as heart injuries or lung collapse

How Are Liver Biopsy Results Interpreted?

A normal liver biopsy shows the following:

• No signs of scarring or fibrosis in the liver / signs present
• No significant fat accumulation in the liver / accumulation present
• No signs of cancer or abnormal cell growth / signs present
• No hepatitis virus inflammation or signs / present
• No abnormal copper levels indicating Wilson disease / abnormal levels present

Abnormal liver biopsy results may indicate several different conditions, including:

• Liver cirrhosis
• Liver cancer
• Autoimmune hepatitis
• Viral hepatitis
• Wilson disease
• Nonalcoholic fatty liver disease

Summary

A liver biopsy can help diagnose several medical conditions. It also helps distinguish one condition from another. A liver biopsy may be requested for people with abnormal liver ultrasound findings, abnormal liver blood test results or major risk factors for liver cancer or other serious liver diseases.

People considering a liver biopsy should discuss its risks and benefits with their doctors and learn about alternatives. For most people, a liver biopsy is safe and unlikely to cause severe pain.