Liver biopsy

A liver biopsy involves inserting a needle between the lower right ribs to collect a small sample of liver tissue. Samples of liver tissue can then be examined under a microscope to further check a suspected or known liver disease.

A liver biopsy may be done after other tests have failed to find a clear diagnosis or failed to find out how severe a liver problem is. It can also be used to monitor certain forms of liver disease, such as hepatitis C. A liver biopsy can reveal long-term inflammation (chronic hepatitis), scar tissue formation (cirrhosis), or cancer.

A needle biopsy of the liver may be done to:

• Find the cause of jaundice. A liver biopsy can find certain liver diseases (such as cirrhosis), infections (such as hepatitis), and liver tumors.
• Find the cause of abnormal blood test results that can help confirm liver disease. Both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels show liver damage.
• See how much the liver is inflamed or scarred by hepatitis or other liver diseases.
• See whether other liver conditions, such as hemochromatosis and Wilson's disease, are present.
• Check the response to treatment for liver disease.
• Find out if a medicine, such as methotrexate, is causing a toxic effect on the liver.
• Check the function of a transplanted liver.
• Find the cause of an unexplained and ongoing fever.
• Check a liver mass found on an X-ray, ultrasound, MRI, or CT scan.

A needle biopsy of the liver is done in a clinic or a hospital. When cirrhosis of the liver or a cancer is suspected, the biopsy may be done during a laparoscopy.

You will need to take off all or most of your clothes. You will be given a cloth or paper gown to use during the biopsy.

Before the biopsy, you may be given a sedative through an I.V. (intravenous) line placed in your arm. The sedative will help you relax and stay still.

During the biopsy, you will lie on your back with your right arm resting under or above your head and your head turned to your left. Your doctor may tap on your chest and belly to find your liver, or the doctor may use ultrasound.

Your doctor will mark a spot between two of your right lower ribs where the biopsy needle will be inserted. The site will be cleaned with a special soap and draped with sterile towels. The doctor will give you a medicine (local anesthetic) to numb the area.

The doctor will ask you to take a deep breath, blow all the air out, and then hold your breath. While you are holding your breath, the doctor will insert the needle to get the small sample of liver tissue and then pull out the needle. This takes only a few seconds. You may feel pressure or dull pain when the needle is inserted. It is important to stay still.

As soon as the doctor removes the needle, you can breathe normally. A bandage will be put on the puncture site.

You will rest in bed and lie on your right side for 2 to 4 hours after the biopsy. After the anesthetic wears off, you may feel a dull pain in your right shoulder. This is called referred pain. It is caused by pain traveling along a nerve near the biopsy site. This usually lasts less than 12 hours. Ask your doctor if you can take acetaminophen (such as Tylenol) for pain. Call your doctor if this does not help.

You can go home if you have no problems after the biopsy.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

The tissue sample is sent to a lab and looked at under a microscope to see if there are any liver problems.

• Samples of liver tissue sent to a pathology lab will be looked at for liver diseases such as liver cancer or cirrhosis.
• Other samples of liver tissue may be sent to a microbiology lab to see whether an infection, such as tuberculosis of the liver, is present.

Results are generally ready in 2 to 4 days. If tests are done to find infections, it may take several weeks for the results to be ready.

Normal

• The liver tissue looks normal under a microscope. No signs of infection, inflammation, cancer, or cirrhosis are present.

Abnormal

• Abnormal cells or liver tissue are present. This may be caused by an infection such as hepatitis, liver disease such as cirrhosis, or cancer. If liver cancer is present, the biopsy can help find the type of cancer. If hepatitis is present, the biopsy can be used to see the chance of developing cirrhosis. Results may also show the severity of cirrhosis.