The Liver Biopsy

A needle biopsy of the liver was first performed in Germany by Paul Ehrlich in 1883 in a study of the glycogen content of the diabetic liver. Later, in France (1907) Schupfer published his findings where the technique was used for the diagnosis of cirrhosis and hepatic tumors.

A biopsy of the liver may be used to aid in establishing liver disease. No single test or procedure is capable of diagnosing or measuring the total function of the liver. Usually a battery of diagnostic tests is utilized involving blood tests, radiological techniques and the liver biopsy. Common indications for performing a liver biopsy are to assess the activity of the disease and to determine the extent of scarring. Specifically, those diagnosed with Hepatitis C a liver biopsy may be indicated if the liver enzymes have been elevated 1.5-2 times the upper limit of normal for greater than six months, if liver function tests (bilirubin, albumin, INR) are abnormal, if abnormal signs or symptoms of liver disease are present, and/or there is uncertainty about the diagnosis or disease activity. As well, a repeat biopsy may be performed to assess improvement after treatment. If there are no intentions to treat the Hepatitis C then it may not be necessary to have a liver biopsy.

There are 4 types of routes by which liver biopsies are performed. The intercostal technique is probably the most common method used. With this technique the needle is inserted manually into the liver int the eighth or ninth intercostal space (between the ribs). A directed (guided) liver biopsy uses ultrasound to assess the liver size and position. A Biopty gun with a needle in the center is triggered by a powerful spring mechanism which allows the needle to enter and exit the liver very quickly. This technique allows for precise positioning of the needle which will give a more accurate sample of liver tissue. This technique is usually less painful than the manual technique. A transvenous (transjugular) liver biopsy is performed when the patient has difficulties with bleeding or clotting. By placing a catheter through the femoral (groin) or jugular (neck) vein and guiding it through the vena cava to the hepatic vein and then to the liver a sample of liver tissue can be obtained. This procedure is much more complex than the previous approaches. Lastly, a liver biopsy can be obtained during surgery or laproscopically.

Prior to performing a liver biopsy the patient's capacity to clot blood is evaluated by taking a blood test for platelet count and INR (time it takes for blood to clot). As well, the blood is cross-matched as a precautionary measure in case blood is required after the procedure. The physician or nurse should explain the procedure to you with regards to fasting before the biopsy. Liver biopsies are commonly done using ultrasound guidance. Done in the radiology department, will lie supine and the skin over the liver area is cleansed and anesthetized with local anesthetic. You will be instructed to take several deep breaths and to hold your breath prior to expiration to bring the liver and diaphragm to the highest position, the needle will then be inserted through the intercostal or subcostal tissue into the liver ( which only takes a few seconds). The liver tissue is placed into an appropriate container and sent to the pathology department to be analyzed. It may take up to two weeks for your doctor to receive the results. After the procedure a pressure bandage will be placed over the site and you may be instructed to lie on your right side for approximately one hour at which time the ultrasound will be repeated to make sure there is no bleeding. Your vital signs will be monitored during this time. You will be able to go home as long as there are no complications. Most people following a liver biopsy carry on their normal activities, however, heavy lifting or straining should be avoided.

Although rare, complications of liver biopsy may be dangerous. Compiled statistics dating back to 1953 on the mortality rate resulting from liver biopsies is about 0.01%, usually due to hemorrhaging. Deaths from hemorrhage are usually only in those who are very ill to begin with and who have a poor prognosis.

Pain at the site from where the biopsy is taken is usually mild and subsides within a day. Bleeding or hemorrhaging may be caused by accidental penetration of blood vessels during the procedure. Accidental puncture of a biliary vessel causing bile to leak into the abdominal cavity may also occur but is extremely rare.

©1997 Natalie Rock, BScN for The HepC BC.

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Correspondence can be directed to Natalie Rock.

HepC BC