A liver biopsy is a procedure that involves taking a small piece of liver tissue for examination with a microscope for signs of damage or disease. The three types of liver biopsy are the following:
- Percutaneous biopsy—the most common type of liver biopsy—involves inserting a hollow needle through the abdomen into the liver. The abdomen is the area between the chest and hips.
- Transvenous biopsy involves making a small incision in the neck and inserting a needle through a hollow tube called a sheath through the jugular vein to the liver.
- Laparoscopic biopsy involves inserting a laparoscope, a thin tube with a tiny video camera attached, through a small incision to look inside the body to view the surface of organs. The health care provider will insert a needle through a plastic, tubelike instrument called a cannula to remove the liver tissue sample.
A health care provider will perform a liver biopsy to
- diagnose liver diseases that cannot be diagnosed with blood or imaging tests
- estimate the degree of liver damage, a process called staging
- help determine the best treatment for liver damage or disease
A person prepares for a liver biopsy by
- talking with a health care provider
- having blood tests
- arranging for a ride home
- fasting before the procedure
Talking with your doctor. Patients should talk with their doctors about medical conditions they have and all prescribed and over-the-counter medications, vitamins, and supplements they take, including
- antibiotics
- antidepressants
- aspirin
- asthma medications
- blood pressure medications
- blood thinners
- diabetes medications
- dietary supplements
- nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
The health care provider may tell the person to stop taking medications temporarily that affect blood clotting or interact with anesthesia, which people sometimes receive during a liver biopsy.
Having blood tests. A patient will have a test to show how well his or her blood clots. A technician or nurse draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. Patients with severe liver disease often have blood-clotting problems that can increase their chance of bleeding after the biopsy. A health care provider may give the person a medication called clotting factor concentrates just before a liver biopsy to reduce the chance of bleeding.
Arranging for a ride home after the procedure. For safety reasons, most people cannot drive home after the procedure. A health care provider will ask a person to make advance arrangements for getting home after the procedure.
Fasting before the procedure. A health care provider will ask a person not to eat or drink for 8 hours before the procedure if the provider anticipates using anesthesia or sedation.
A liver biopsy is performed by a gastroenterologist, hepatologist, radiologist, or surgeon in a clinic or a hospital. A liver biopsy is often done by a radiologist using ultrasound or a CT scan to help guide the biopsy needle. A liver biopsy may be done during a laparoscopy when cirrhosis of the liver or a cancer is suspected.
How is a liver biopsy performed?
A gastroenterologist, hepatologist, radiologist, or surgeon performs the liver biopsy at a hospital or an outpatient center and determines which type of biopsy is best for the person.
Percutaneous liver biopsy is the most common type of liver biopsy.
Percutaneous Liver Biopsy
A patient lies face up on a table and rests the right hand above the head. A physician gives the person a local anesthetic on the area where he or she will insert the biopsy needle. If needed, the physician will give the person sedatives and pain medication.
The health care provider either taps on the abdomen to locate the liver or uses one of the following imaging techniques:
Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.
Computerized tomography (CT) scan. A CT scan uses a combination of x rays and computer technology to create images. For a CT scan, a technician may give the person a solution to drink and an injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the technician takes the x rays.
Research has shown fewer complications after biopsy when health care providers use ultrasound to locate the liver compared with tapping on the abdomen.1 Health care providers may select ultrasound over a CT scan because it is quicker and less expensive, and can show the biopsy needle in real time.2
The health care provider will
make a small incision in the right side of the person’s abdomen, either toward the bottom of or just below the rib cage
insert the biopsy needle
ask the person to exhale and hold his or her breath while the health care provider inserts the needle and quickly removes a sample of liver tissue
insert and remove the needle several times if multiple samples are needed
place a bandage over the incision
After the biopsy, the person must lie on his or her right side for up to 2 hours to reduce the chance of bleeding. Medical staff monitor the person for signs of bleeding for 2 to 4 more hours.
Transvenous Liver Biopsy
When a person’s blood clots slowly or the person has ascites—a buildup of fluid in the abdomen—the physician may perform a transvenous liver biopsy.
For this procedure, the patient lies face up on an x-ray table, and the doctor applies local anesthetic to one side of the neck. The health care provider will give sedatives and pain medication if the person needs them.
The doctor will
make a small incision in the neck.
insert a sheath into the jugular vein and thread the sheath down the jugular vein, along the side of the heart, and into one of the veins in the liver.
inject contrast medium into the sheath and take an x ray. The contrast medium makes the blood vessels and the location of the sheath clearly visible on the x-ray images.
thread a biopsy needle through the sheath and into the liver and quickly remove a liver tissue sample.
insert and remove the biopsy needle several times if multiple samples are needed.
carefully withdraw the sheath and close the incision with a bandage.
Medical staff monitor the person for 4 to 6 hours afterwards for signs of bleeding.
Laparoscopic Liver Biopsy
Physicians use this type of biopsy to obtain a tissue sample from a specific area or from multiple areas of the liver, or when the risk of spreading cancer or infection exists. A surgeon may take a liver tissue sample during laparoscopic surgery performed for other reasons, including liver surgery.
The patient lies on his or her back on an operating table. A nurse or technician will insert an intravenous (IV) needle into the person’s arm to give anesthesia. The health care provider will
make a small incision in the abdomen, just below the rib cage
insert a cannula into the incision and fill the abdomen with gas to provide space to work inside the abdominal cavity and to see the liver
insert a biopsy needle through the cannula and into the liver and quickly remove a liver tissue sample
insert and remove the biopsy needle several times if multiple samples are needed
After a liver biopsy, a patient can expect
full recovery in 1 to 2 days.
to avoid intense activity, exercise, or heavy lifting for up to 1 week.
soreness around the biopsy or incision site for about a week. Acetaminophen (Tylenol) or other pain medications that do not interfere with blood clotting may help. People should check with their health care provider before taking any pain medications.
a member of your health care team to review the discharge instructions with you, the patient—or with an accompanying friend or family member if you are still groggy—and provide a written copy. The patient should follow all instructions given.
Liver biopsy results take a few days to come back. The liver sample goes to a pathology lab where a technician stains the tissue. Staining highlights important details within the liver tissue and helps identify any signs of liver disease. The pathologist—a doctor who specializes in diagnosing diseases—looks at the tissue with a microscope and sends a report to the person’s health care provider.
After the test
if you develop any of the following complication after surgery, please call 911 or other emergency services immediately:
Signs of shock, such as passing out, or feeling very dizzy, weak, or less alert.
Severe pain in your chest, shoulder, or belly.
Moderate to severe trouble breathing.
Please call your doctor if you have any of the follow symptoms post-operation:
chest pain
difficulty breathing
increasing abdominal pain
dizziness
bleeding from the incision or biopsy site
abdominal swelling or bloating
fever
swelling or redness at the incision or biopsy site
nausea or vomiting
After a liver biopsy, a patient can expect
full recovery in 1 to 2 days.
to avoid intense activity, exercise, or heavy lifting for up to 1 week.
soreness around the biopsy or incision site for about a week. Acetaminophen (Tylenol) or other pain medications that do not interfere with blood clotting may help. People should check with their health care provider before taking any pain medications.
a member of your medical team to review the discharge instructions with the you, the patient—or with an accompanying friend or family member if the patient is still groggy—and provide a written copy. The patient should follow all instructions given.
Liver biopsy results may take a few days to come back. The liver sample goes to a pathology lab where a technician stains the tissue. Staining highlights important details within the liver tissue and helps identify any signs of liver disease. The pathologist—a doctor who specializes in diagnosing diseases—looks at the tissue with a microscope and sends a report to the person’s physician.
remove the cannula and close the incisions with dissolvable stitches
The surgeon can easily spot any bleeding from the procedure with the camera on the laparoscope and treat it using an electric probe. The patient stays at the hospital or an outpatient center for a few hours while the anesthesia wears off.