Liver Biopsy

What is a liver biopsy?

A liver biopsy is a test used to diagnose liver conditions. Tissue samples are removed from your liver and checked under a microscope for signs of damage or disease.

A liver biopsy can tell if there are cancer cells or other abnormal cells in your liver. It can also tell how well your liver is working.

There are 3 types of liver biopsies:

• Percutaneous liver biopsy. This is the most common method. You are given a local anesthetic. You may be given medicine through an IV to help you relax. This medicine may make you sleepy. A small needle is put through the skin into your liver to take a sample.

• Laparoscopic liver biopsy. You are given a general anesthetic. A thin lighted tube (laparoscope) is put into your skin through a tiny cut (incision). The tube has a tiny video camera attached. Your healthcare provider can see the inside of your belly on a computer screen. A needle is put through another tube to remove the sample.

• Transvenous liver biopsy. This method may be used if you have blood-clotting problems or fluid in your belly. It's also done if you need a liver biopsy while pregnant. You are given a local anesthetic. An incision is made into a vein in your neck. A hollow tube is put through the vein down to your liver. A contrast dye is put into the tube and X-rays are made. The dye lets the vein show up more clearly on the X-rays. A needle goes through the tube to your liver. Tissue samples are removed through the tube.

If your healthcare provider wants to sample a certain part of your liver, the biopsy may be done in the radiology department. It will be guided using an imaging test such as:

• Ultrasound. This test uses high-frequency sound waves to make images.

• MRI. This test uses a combination of large magnets, radio waves, and a computer to make images.

• CT scan. This test uses both X-rays and computer technology to make images of organs and tissues of the body.

Why might I need a liver biopsy?

A liver biopsy is used to see if you have liver conditions that can’t be diagnosed by symptoms or lab tests. A biopsy may be done if you have:

• An enlarged liver

• Yellowing of the skin and eyes (jaundice)

• Abnormal lab tests that suggest liver disease

A liver biopsy may be used to see if you have a condition such as:

• Hepatitis. This is a redness and swelling (inflammation) of the liver that sometimes causes long-lasting damage. It's caused by viruses, illegal drugs, alcohol, parasites, or other conditions.

• Alcoholic liver disease. This is liver damage caused by alcohol abuse.

• Nonalcoholic liver disease. This is liver disease caused by the accumulation of fat in the liver. This is more likely in people with metabolic syndrome, or who have high lipids, high blood pressure, obesity, and diabetes.

• Liver tumor. This is an abnormal lump or mass of tissue. Tumors can be noncancer (benign) or cancer (malignant).

• Fatty liver. This is a buildup of fat in the liver cells.

• Metabolic or autoimmune disease.

• Fibrosis of the liver. This is the growth of scar tissue due to infection, inflammation, injury, or even healing.

Your provider may have other reasons to recommend a liver biopsy.

What are the risks of a liver biopsy?

Some possible complications may include:

• Pain and bruising at the biopsy site

• Bleeding for a long time from the biopsy site, either inside or outside the body

• Infection near the biopsy site

• Accidental injury to another organ

If your liver biopsy is done using X-rays, the amount of radiation used is small. The risk for radiation exposure is low.

In some cases, a liver biopsy may not be advised. This includes cases where you have:

• A condition that affects the blood's ability to clot

• A lot of fluid collecting in your belly (severe ascites)

• An infection of your biliary tract or the part of your belly around your liver

You may have other risks that are unique to you. Talk about any concerns with your healthcare provider before the procedure.

How do I get ready for a liver biopsy?

• Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.

• You will be asked to sign a consent form that gives permission to do the procedure. Before you sign it, read the form carefully and ask questions if anything is not clear.

• Your provider will ask questions about your past health. They may give you a physical exam. This is to make sure you are in good health before you have surgery. You may also need blood tests and other diagnostic tests.

• Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).

• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.

• Tell your provider if you have a history of bleeding disorders or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the biopsy.

• Tell your provider if you are pregnant or think you may be pregnant.

• Follow any directions you are given for not eating or drinking before the biopsy.

• You may be given medicine to help you relax (a sedative) before the surgery. The sedative may make you drowsy. So, someone must drive you home.

Your healthcare provider may have other instructions for you based on your health condition.

What happens during a liver biopsy?

You may have a liver biopsy as an outpatient. This means you go home the same day. Or it may be done as part of your stay in a hospital. A liver biopsy may be done in a procedure room, in a hospital bed, or in the radiology department. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, a percutaneous liver biopsy follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may get in the way of the scan.

2. You will be given a gown to wear.

3. You will be asked to go to the bathroom before the biopsy.

4. An IV (intravenous) line may be started in your arm or hand. Some people are given IV sedation and get sleepy for the biopsy.

5. You will be placed on your back with your right arm above your head, or on your left side.

6. Your provider will find your liver by pressing on your belly. They will mark the area where the biopsy will be done. An ultrasound, MRI, or CT scan may be used to find a specific spot in the liver.

7. The skin over your liver will be washed with a sterile (antiseptic) solution.

8. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging feeling.

9. A needle will be put through your skin and into your liver very quickly. It's common to feel pressure as the needle is pressed into your liver. You may feel mild pain in your shoulder due to irritation of the phrenic nerve. This nerve passes down the shoulder and near the liver.

10. You will be asked to hold your breath as the needle goes quickly in and out of your liver. Holding your breath stops your chest wall and diaphragm from moving. Any movement may affect the placement of the biopsy needle. You should lie quietly without moving.

11. The sample of liver tissue will be removed.

12. Your provider may need more than one tissue sample. If so, you will hold your breath as the needle is put quickly in and out of your liver again.

13. The biopsy needle will be taken out. Firm pressure will be applied to the biopsy site until the bleeding has stopped.

14. A sterile bandage or dressing will be applied.

15. The liver tissue sample will be sent to the lab for testing.

What happens after a liver biopsy?

Your recovery process will vary depending on the type of biopsy you had and your provider’s practices. You may be taken to the recovery room to be watched if your biopsy was done in a procedure room or in the radiology department.

Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to a hospital room or discharged to your home.

You will be asked to rest quietly, lying on your right side, for 1 to 2 hours. This will put pressure on the biopsy site. Depending on your condition and your healthcare provider's preferences, you may be told to stay on bed rest for an additional 4 to 24 hours.

A blood sample may be taken a few hours after the biopsy to check for possible internal blood loss.

If you are discharged home within a few hours after the procedure, you may be told to stay on bed rest at home for a certain amount of time.

Leave the bandage in place for as long as instructed, often until the next day.

You will be told to not do any intense activity, such as heavy lifting, for several days, or up to a week or longer. You should not cough hard or strain for a few hours after the biopsy.

The biopsy site may be sore for a few days. Take a pain medicine as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Only take medicines that your provider has approved.

Call your healthcare provider if you have any of the following:

• Fever or chills

• Redness, swelling, warmth, or bleeding or other drainage from the biopsy site

• More pain around the biopsy site or elsewhere

• Shortness of breath or trouble breathing

• Rectal bleeding

You may go back to eating normally unless your healthcare provider has other instructions.

Your provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure