Liver Biopsy Procedure

A liver biopsy is a diagnostic procedure that involves inserting a needle through a small incision in the skin of the abdomen and into the liver to extract a small sample of liver tissue. The extracted tissue is then examined under a microscope for signs of scarring, fibrosis, cirrhosis, cancer, or infectious hepatitis. A biopsy is performed whenever certain other diagnostic tests reveal a likelihood of serious liver disease.

The indicator tests include elevated levels of serum liver enzymes, especially aspartate aminotransferase (AST) and alanine aminotransferase (ALT), as well as signs of abnormal growth and fatty deposits revealed by any of several types of medical imaging such as an ultrasound or MRI (magnetic resonance imaging), and certain external symptoms such as jaundice (yellowing of the skin or the whites of the eyes), abdominal swelling, and chronic pain in the abdomen over the region of the liver. Up to three samples of liver tissue may be extracted in the course of a biopsy procedure.

Pain

Patients are asked not to take any pain medication prior to having the biopsy done, as this can interfere with the results. Other medications which should be avoided are any that affect blood clotting or that interact with sedatives, including anti-inflammatory drugs (e.g., aspirin or ibuprofen), blood thinners, medications for high blood pressure or diabetes, antibiotics, and antidepressants. Local anesthetic and, for some patients, a sedative are administered prior to the procedure, which for most patients (although there are some exceptions) is not reported as especially painful. Pain medication can be given immediately afterward if necessary, however.

Patients are kept for several hours after the procedure to ensure that no serious complications occur. Results come back from the biopsy normally in a few days. Most patients fully recover from a liver biopsy within one or two days. The incision site may be somewhat sore for as much as a week after the procedure. This is normal and not a cause for concern.

Complications

The most frequent risk of liver biopsy is pain at the biopsy site. This occurs in about one patient in twenty. It is not a serious problem and can be treated with normal pain medications after the procedure is complete (in fact, the same procedure as was used to perform the biopsy itself is sometimes used to inject pain medication internally).

More serious (and rarer) complications include bleeding (occurring in roughly one patient in 500 to one in 1,000), which can occur because liver disease can sometimes result in deficiency of clotting agents in the blood. Normally a blood test is done before the biopsy to test the blood’s ability to clot, and a variation on the procedure that involves threading a flexible needle through a vein from the neck down to the liver is used rather than the normal insertion through the abdomen.

Excessive and uncontrolled bleeding can result in mortality in about 1 in 10,000 to 12,000 cases. If the patient suffers from liver cancer, it is possible to transfer cancer cells to other parts of the body in the course of the biopsy, a process called cancer “seeding.” It is also possible, although not common, for a poorly-performed biopsy to puncture other internal organs or to cause damage to the liver.

The risk of serious complications is low, but a biopsy should still not be performed unless other indications of liver disease are present and there is concern that a serious and potentially life-threatening condition such as liver cancer or hepatitis is involved.