When you have a liver biopsy, small pieces of liver tissue are removed so they can be sent to a lab for examination. The appearance of the cells can reveal a great deal about the health of your liver. Your doctor may recommend a liver biopsy if other tests have suggested that your liver is not working properly. Taking a tissue sample using a liver biopsy is the best way to determine the exact condition of the liver.
Why would I need a liver biopsy?
It may be that you have had a blood test that revealed elevated levels of liver enzymes or copper or iron in your system. In some cases, an X-ray may have shown that the liver is enlarged or inflamed so a liver biopsy is required to discover the nature of the problem and what is causing it.
A liver biopsy can detect and assess various diseases that affect the liver including:
- Alcoholic liver disease
- Fatty liver disease
- Raised levels of liver enzymes
- Bile duct obstruction
- Wilson’s disease
- Autoimmune liver disease
- Drug damage to the liver
- Hepatitis B or C: chronic infection with either of these viruses can lead to liver fibrosis and liver cirrhosis
- An enlarged or inflamed liver
- Liver cancer
- Liver cysts
A liver biopsy can also help monitor how medicines and treatments are affecting your liver. If you are being given drugs for diseases such as chronic viral hepatitis or HIV/AIDS, it is important to make sure your liver is coping. There is increasing evidence that some of the newer drugs for hepatitis B can allow the liver to heal and signs of fibrosis regression have been detected. It is, therefore, important to have a biopsy every few years to find out whether this has happened. A liver biopsy can also be used to detect rejection or infection following a liver transplant.
Before and after
Before the liver biopsy goes ahead, you will need a blood test so that tests can be done to make sure your blood is clotting normally. If it is not clotting well, you may have problems with bleeding both during the procedure and afterwards. Your doctor will ask you about any medication you are taking for stroke prevention, such as warfarin or the newer blood thinners such as dabigatran (Pradaxa®). You might need to stop taking these for the few days around your liver biopsy.
The actual liver biopsy is done with a local anaesthetic and does not take very long; it is not a pleasant procedure but it is not painful and you should not be uncomfortable. There are three main methods used, which are described in detail below.
After your procedure, you will need to lie down and relax so that you can be monitored to make sure the tissues affected by the biopsy are not going to bleed. Unless your liver biopsy is done first thing in the day, this might mean an overnight stay in hospital.
What are the risks?
Like any medical procedure that is invasive, liver biopsy does carry some risks. You may experience some discomfort afterwards, but this can be managed with painkillers. You may experience a reaction to the local anaesthetic. More serious but rare complications include having your gallbladder or lung accidentally punctured, getting an infection, having a lot of bleeding, and experiencing more than a little pain afterwards.
A percutaneous liver biopsy
If you have a percutaneous liver biopsy, the sample of liver tissue will be taken by penetrating the skin. Your liver is situated under your diaphragm and ribs on your right side so when you undergo a liver biopsy you will need to lie down on your left side so that the doctor doing your biopsy can insert the needle correctly.
After your skin has been swabbed with antiseptic, you will be given an injection of local anaesthetic to numb the area so that you don’t feel any pain as the tissue is being removed.
The biopsy is taken using a long, hollow needle which is inserted into the skin and through to the liver tissue. This should not be painful but you will have the sensation of pressure as the needle enters the liver. As the needle is pulled out, it sucks out a small sample of liver tissue that can then be examined.
A percutaneous liver biopsy with image guidance
During a percutaneous liver biopsy, a real-time ultrasound scan may be used to guide the needle. This is painless and helps the doctor to locate the exact site of the liver that he or she wants to investigate.
Having it using laparoscopic techniques
A laparoscope is a telescope that magnifies the objects it sees. This is a form of minimally invasive surgery, which can be done to carry out much more major procedures than a liver biopsy. Four to five ports are made through the skin of the abdomen and the surgical instruments pushed through them and used to take the tissue samples. Ultrasound guidance can also be used to take samples from specific points in the liver.
It is possible to have a non-invasive scan that tests the ‘stiffness’ of the liver; different companies have produced the equipment to do this and although they can detect some problems, they are not as effective as a liver biopsy. It is likely that the technology will develop further in the future and the number of people having liver biopsies could reduce as scanning methods are perfected.