Biopsy is the process by which a health care practitioner removes, examines, and analyzes a small tissue sample.
Percutaneous liver biopsy, the most common type of liver biopsy, is performed by inserting a needle through the skin, usually between the ribs, and into the liver to obtain a small sample of tissue.
Occasionally, transjugular liver biopsy, which allows physicians to obtain a sample of liver tissue through a vein instead of the skin, is used in patients with liver failure.
TIPS, a procedure that treats portal hypertension, may be performed directly after a liver biopsy.
A biopsy is the process by which a physician removes, examines, and analyzes a tissue sample. A liver biopsy yields information about whether liver disease is present and the type and severity of the condition.
Liver biopsy is used to:
Diagnose liver cancer, hepatitis, or metastases (or other growths within the liver);
Diagnose the extent of cirrhosis, which causes portal hypertension; and
Check for rejection after a liver transplant.
Biopsies usually are performed after another test indicates the presence of an abnormality.
There are two types of liver biopsy:
Percutaneous biopsy involves inserting a thin needle through the skin to obtain a small sample of liver tissue; and
Transjugular biopsy is performed using a catheter (long, thin, flexible tube) that is inserted into the jugular vein and is guided through a person's venous system into the hepatic vein in the liver, where a needle retrieves a tissue sample.
The physician will:
Perform a careful medical history and physical examination; and
Order blood tests, an ultrasound scan, or an x ray.
The patient may be asked to:
Stop taking aspirin 7 days before the biopsy;
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, 3 days before the test; and
Fast for 8 hours before the biopsy.
WHAT TO EXPECT
Percutaneous biopsy. A point on the upper chest is shaved, cleaned, and numbed with a local anesthetic, and the needle is inserted. When the needle reaches the liver's edge, the patient is asked to exhale and hold his or her breath for about 20 seconds. The physician inserts the needle into the liver and retrieves the biopsy sample. Percutaneous biopsy usually takes 20 minutes.
Transjugular biopsy. The insertion point on the neck is shaved, cleaned, and numbed with a local anesthetic, and a sedative is given. The physician accesses the jugular vein and guides a catheter to the hepatic vein. Most people feel only a slight pressure or a sensation of mild tugging during the insertion; the procedure is relatively painless. A needle attached to the end of a catheter is advanced to the liver and extracts a tiny core of tissue. The test typically takes 45 to 60 minutes.
POST-TEST GUIDELINES AND CARE
In either procedure, pressure is applied on the insertion site for 15 minutes to allow the puncture area to close and prevent bleeding.
Percutaneous biopsy. The patient is rolled on his or her right side and is told to lie that way for 1 hour to help prevent internal bleeding or bile leakage. Hospital staff will monitor the patient's vital signs until the patient is discharged, usually 3 to 6 hours after the test.
Transjugular biopsy. Hospital staff members monitor the patient several hours after the procedure; patients are discharged from the hospital that same day.
Percutaneous biopsy. Minor complications include shoulder or abdominal pain and bruising.
The following serious complications occur in less than 1 percent of biopsies:
Hemorrhage in the liver, abdomen, bile ducts, or gallbladder;
Pneumothorax, hemothorax, or emphysema; and
Transjugular biopsy. Minor complications include:
Muscle stiffness; and
Minor abdominal pain.
More serious complications that are reported less frequently include:
Carotid artery puncture;
Abdominal bleeding; and
If the patient has severe, persistent abdominal pain or otherwise suspects a complication, he or she should alert the physician.