Liver biopsy
A liver biopsy is a medical procedure that involves obtaining a small sample of liver tissue for diagnostic purposes. This procedure is typically performed to assess liver disease, diagnose conditions such as liver cancer or adenocarcinoma liver metastasis, and evaluate the extent of liver damage. It is often indicated when abnormalities are detected through imaging techniques like ultrasound, CT scans, or MRIs, or to investigate unexplained jaundice.
There are several methods for conducting a liver biopsy, including fine needle aspiration, laparoscopic biopsy, and transjugular biopsy, each chosen based on the patient's specific situation. Preparation for the biopsy generally requires patients to refrain from certain medications and food intake prior to the procedure. After the biopsy, patients typically need to rest and may experience some discomfort at the site. While the procedure is considered safe, there are potential risks, including complications like internal bleeding or infection, with a very low mortality rate.
Recent advancements in the field have introduced non-invasive blood tests and improved imaging techniques, making the process more precise and patient-specific. The results of a liver biopsy can provide crucial information to guide effective treatment strategies based on the presence of cancerous or noncancerous tissue.
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Subject Terms
Liver biopsy
ALSO KNOWN AS: Liver needle biopsy, fine needle aspiration biopsy, laparoscopic liver biopsy, transvenous or transjugular liver biopsy
DEFINITION: A liver biopsy involves removing a small sample of liver tissue through a needle or surgically. The tissue sample is then examined in the laboratory for the presence of cancer cells.
Cancers diagnosed: Liver cancer
Why performed: A liver biopsy is performed to diagnose liver disease and assess the degree of liver damage (disease staging). It may be performed when a liver abnormality is found during an ultrasound,computed tomography (CT) scan, magnetic resonance imaging (MRI) test, or nuclear scan. It may also be performed to determine the cause of unexplained jaundice (yellowing of the skin) or abnormal results of liver function blood tests.
Patient preparation: One week before the procedure, patients must stop taking aspirin and products containing aspirin, ibuprofen, and anticoagulants, as directed by the physician. A blood test will be performed before the procedure to evaluate the patient’s blood and platelet count and clotting ability of the blood. Patients must not eat or drink for eight hours beforehand.
Steps of the procedure: In fine needle aspiration biopsy, an intravenous (IV) line is inserted into a vein in the patient’s arm to deliver medications. In many hospitals, a sedative is given to the patient before the procedure (conscious sedation) so that the patient is awake but relaxed and able to respond to the physician’s instructions during the procedure. The patient lies on the back, with the right hand above the head, remaining as still as possible during the procedure. The biopsy site is cleansed, and a local anesthetic is injected into the area where the needle will be inserted. A small is made on the right side of the chest, near the rib cage. Ultrasound is often used to guide the biopsy needle that is placed through the incision into the liver. The physician may ask the patient to hold their breath for up to ten seconds while the needle is placed in the liver. A small sample of liver tissue is removed through the needle for analysis in a laboratory.
During a laparoscopic biopsy, a laparoscope (a small camera on a thin tube) is inserted into a small abdominal incision. The laparoscope transmits magnified images of the liver onto a video monitor to guide the physician as laparoscopic instruments are inserted through additional small abdominal incisions to remove tissue samples from one or more parts of the liver. General anesthesia is usually used with this type of biopsy. A laparoscopic biopsy may be used when a tissue sample is needed from more than one area of the liver or when a larger tissue sample is needed.
During a transvenous biopsy (also called transjugular biopsy), a (thin tube) is inserted into a vein in the neck and guided to the liver. A biopsy needle is inserted through the catheter to collect the sample of liver tissue. This technique is not common, but it may be used for certain high-risk patients, including those who have a blood-clotting disorder, fluid in the abdomen, or liver failure or who are morbidly obese.
Advances in liver biopsy in the first decades of the twenty-first century have included the increased use of endoscopic ultrasound-guided liver biopsy and new needle technology for retrieving tissue samples. The use of digital pathology in conjunction with advances in tissue analysis has made the diagnosis and the formation of a treatment plan more patient-specific. Blood tests identifying specific biomarkers for liver diseases have also emerged as a non-invasive alternative to liver biopsy.
After the procedure: The patient stays in a recovery room and lies on the right side for four to six hours after the procedure. Pain medication may be prescribed, if needed, to relieve minor discomfort or pain in the shoulders or back. The patient should not drive or operate machinery for eight hours after the procedure. Depending on the physician’s instructions, the patient may be required to stay on bed rest at home for eight to ten hours after the procedure. The patient should avoid vigorous physical activity and heavy lifting, as directed by the physician. The patient may feel discomfort at the incision site and in the right shoulder for a few hours to a few days after the procedure. For one week after the biopsy, the patient should avoid aspirin and products containing aspirin, ibuprofen, and anticoagulants, as these medications decrease blood clotting, which is necessary for healing. The patient may take acetaminophen (Tylenol) to relieve pain as needed after the procedure.
Risks: With ultrasound guidance, liver biopsy is a relatively safe procedure. Although rare, the complications of a liver biopsy include a puncture of the lung or gallbladder that may result in bile leakage, internal bleeding, and infection. The risk of death (mortality rate) of the liver biopsy procedure is approximately 0.1 to 0.2 percent, according to the American Association of Family Physicians.
Results: The tissue sample that was removed during the procedure may be (noncancerous) or (cancerous). The type of cancerous cells and extent of the disease will help guide the patient’s treatment.
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