<< Back to Infosheets

BIOPSY OF THE LIVER

What Is A Biopsy Of the Liver?

A biopsy of the liver is a diagnostic procedure used to obtain a small amount of liver tissue. The tissue can then be examined under a microscope to help identify the cause or severity of liver disease.

In What ways can A Biopsy Be Performed?

The most common way a liver sample is obtained is by inserting a needle into the liver through a tiny incision in the skin for a fraction of a second. This can be done as an outpatient in a hospital, ambulatory surgical center or radiology facility. The patient may be send home within 1-3 hours if there are no complications. The skin and area under the kin is anesthetized, and a needle is passed quickly into and out of the liver. While the majority of patients experience no pain after the procedure, a variable number of individuals have brief localized pain that often spreads to the right shoulder.

Another technique used for liver biopsy is guiding the needle into the liver through the abdomen or chest using various imaging techniques. This approach is used when there are identified localized tumors. After this procedure the patient is usually allowed to go home the same day. Other liver biopsy techniques include laparoscopy, transvenous or transjugular liver biopsy, and surgical liver biopsy. During laparascopy, a lighter, narrow tubular instrument is inserted through a small incision in the abdomen wall. Gas is then introduced into the abdomen in order to move the organs away from the abdominal wall. This makes it easier to pass instruments through this lighted tube or through separate puncture sites to obtain tissue samples from different areas of the liver. The patient is generally discharged several hours later. Transvenous or transjugular biopsies may be performed by radiologist in special circumstances. For example, when the patient has a significant problem with blood clotting, known as coagulopathy, or has accumulated a large amount of fluid within the abdomen, commonly referred to as ascites. During this procedure a small tube is inserted into the jugular vein in the neck and then radiologically guided into the hepatic vein. At that moment a small biopsy needle is inserted through the tube and into the liver to obtain a sample of tissue. A biopsy of the liver can also be performed at the time of an open abdominal operation, enabling the surgeon to inspect the liver and take one or more biopsy samples as needed.

Although various studies are being conducted to find a non-invasive liver biopsy, such as FibroTest, FibroMax, and FibroScan none have been approved in the US. Liver biopsy remains the "gold standard" for staging liver disease.

When is a Liver Biopsy Necessary?

Although the specific cause of a chronic liver disease is often suspected based on elevated blood tests or an enlarged liver, a biopsy is used to diagnose the cause. A biopsy not only confirms the diagnosis, but determines the amount of damage to the liver as well. It is also used to diagnose identified liver tumors after imaging tests. Liver biopsies are also often necessary after liver transplantation in order to investigate the cause of elevated liver tests and determine if refection is present.

Are there Any Dangers Involved With Liver Biopsies?

Considered a very low risk (less than 1%), the most important risk of a liver biopsy is bleeding from the site where the needle is inserted. Other uncommon complications may include the puncture of the other organs such as the kidney, lung or colon. Also, a biopsy by mistake of the gallbladder may cause leakage of bile into the abdominal cavity, thus causing peritonitis. This is extremely uncommon since nearly all liver biopsies are performed under image guidance. The risk of death due to a liver biopsy is extremely low (0.01%).

Are There Any Alternatives?

Although a physical examination of the patient, medial history, and blood testing are quite accurate in giving the doctor the information to diagnose chronic liver disease, in many circumstances a liver biopsy is needed to assure an accurate diagnosis and determine the extent of damage if any, to the liver.

© Copyright 1999 - Latino Organization for Liver Awareness

Revised on March 2009 by: Dr. David Stein, Gastroenterologist