Liver Biopsy

What is a liver biopsy?

A liver biopsy is a minor procedure to take a tiny tissue sample from your liver through a hollow needle. Healthcare providers do this in a few different ways, depending on your condition. After the procedure, a pathologist analyzes the tissue sample in a lab to help diagnose and stage various liver diseases.

Why would I need a liver biopsy?

Reasons for a liver biopsy include:

• Diagnosis. Healthcare providers consider liver biopsy to be the gold standard for diagnosing many liver diseases and lesions that other tests might suggest but can’t confirm. It can definitively confirm or rule out these conditions. Sometimes it’s the only way to do this.
• Staging. You may also have a liver biopsy to check how your chronic liver disease is progressing. A biopsy can determine the level of fibrosis (scarring) in your liver and score it (F0-F4). This helps to forecast your prognosis, inform your treatment plan and check how well it’s working.

What conditions can a liver biopsy diagnose?

A liver biopsy can diagnose certain general liver conditions, such as:

• Fatty liver disease.
• Chronic hepatitis.
• Cirrhosis of the liver.
• Liver cancer.

It also can isolate specific causes or types of liver disease, such as:

• Alcohol-related liver disease.
• Autoimmune hepatitis.
• Glycogen storage disease.
• Hemochromatosis.
• Hepatocellular carcinoma (HCC).
• Hodgkin lymphoma.
• Metastatic cancer.
• Non-alcohol related fatty liver disease.
• Non-Hodgkin lymphoma.
• Primary biliary cholangitis.
• Primary sclerosing cholangitis.
• Toxic hepatitis.
• Tuberculosis.
• Wilson disease.
• Viral hepatitis (B or C).

How is a liver biopsy done?

There are three types of liver biopsy procedures. Each one is done a little differently.

Percutaneous liver biopsy

The most common type of liver biopsy is a percutaneous liver biopsy. “Percutaneous” means “through the skin.” This means that a healthcare provider inserts the biopsy needle directly through the skin of your abdomen and into your liver. This is the least invasive method, which is why it’s often a first choice.

Transvenous liver biopsy

You might have a transvenous liver biopsy instead if you have a bleeding disorder or too much fluid in your abdomen. “Transvenous” means “through a vein.” In this procedure, the biopsy needle passes through a tiny catheter in your jugular vein to reach your liver. It’s also called a transjugular liver biopsy.

Surgical liver biopsy

Sometimes you might have a liver biopsy during abdominal surgery that you’re having for another purpose. This can happen during open abdominal surgery or laparoscopic surgery. Surgeons perform laparoscopic surgery through small “keyhole” incisions with the aid of a tiny camera (laparoscope).

Do you go to sleep for a liver biopsy?

Unless you’re having surgery, you probably won’t have general anesthesia for a liver biopsy. Healthcare providers prefer you to be conscious for the procedure so that you can participate, if needed. For example, they might ask you to hold your breath briefly. But you can have sedation if you wish.

What’s the preparation for a liver biopsy?

Preparation for a liver biopsy procedure includes:

• Medical consultation. A healthcare provider will review your health history, current conditions and medications to determine if you’re physically fit for the procedure. They might ask you to discontinue certain medications, like blood thinners and NSAIDs, for the week before.
• Blood tests. You’ll have blood tests in advance to measure your total number of blood cells and platelets and to check how well your blood clots to stop a bleed. If your platelet count is low, you might receive a transfusion before your biopsy to boost your blood clotting ability.
• Sometimes fasting. Your healthcare provider might ask you to avoid eating and drinking for up to eight hours before the procedure. These requirements might depend on the type of liver biopsy you’re having and other factors. Follow your healthcare provider’s instructions.
• Planning ahead. If you’re having sedation for the procedure, you’ll need to plan for someone else to drive you home. Let them know you’ll be at the hospital for up to four hours before you’re discharged. You should also plan to take it easy during the following week.

How long does a liver biopsy take?

The procedure itself takes about 15 to 30 minutes for a percutaneous biopsy or 30 to 60 minutes for a transvenous biopsy. But you’ll be in the hospital for several hours after that, under observation.

What happens on the day of the procedure?

Prior to the procedure, you may have:

• Imaging. The healthcare provider performing your liver biopsy might want to locate the spot where they’ll insert the needle in advance, using radiology imaging. They might do this with an ultrasound or a CT scan (computed tomography scan). Some providers find the spot just by tapping on your abdomen.
• Sedation. If you’re having a percutaneous or transvenous liver biopsy, you may choose to have a little medication to help you relax. If you do, a healthcare provider will install an IV line into one of your veins to deliver medication and fluids. (For surgery, you’ll have general anesthesia.)

During the biopsy procedure:

1. You’ll lie on your back and a healthcare provider will clean and sterilize the site on your skin where the needle will go in. For a percutaneous liver biopsy, this is over your liver, under your right ribcage. For a transvenous liver biopsy, it’s over your jugular vein in the side of your neck.
2. A healthcare provider will inject a local anesthetic (such as lidocaine) into the site to numb the area. This may sting for a minute before the numbing sets in. Once you’re numb, your healthcare provider will make a small incision in the skin to make way for the biopsy needle.
3. The biopsy needle is hollow and about the diameter of a paper clip. There are two general types: a suction needle and a cutting needle. The suction type (core aspiration needle) draws in the tissue sample with a syringe. The cutting type has a spring-loaded cutting mechanism inside it.
4. Your provider will locate the correct spot on your liver and select the type of needle they want. Different types are better for different purposes. They’ll ask you to lie very still and may ask you to hold your breath for a few seconds as they direct the needle to the right spot in your liver.
5. If you’re having a percutaneous liver biopsy, this part is quick. They’ll consult their radiology images, and the needle will go in and out in a matter of seconds. You might feel some pressure when the needle goes in. When it comes out, they’ll apply pressure and bandage the site.
6. For a transvenous liver biopsy, your provider will use fluoroscopy, a type of X-ray imaging, to see where your vein connects to your liver. They’ll inject a contrast dye into the vein to make it show up. Then they’ll insert a thin catheter into the vein and thread it down to your liver. They’ll thread the biopsy needle through the catheter to reach your liver and take the sample.
7. After bandaging your incision, they’ll position you on your right side. You’ll stay in this position for a few minutes. Lying on your right side applies pressure to your liver. This is meant to help stop it from bleeding, in the same way that you apply pressure to a bleeding flesh wound.

How painful is a liver biopsy?

The most pain you’ll feel during the procedure is from the injection of local anesthetic in your skin. This will numb the area for the biopsy needle, but it does sting for a minute before it starts working. After that, the biopsy itself shouldn’t be painful, though you might feel deep pressure or vague discomfort.

What happens after the procedure?

You’ll rest quietly in a recovery room for the next two to four hours. Your healthcare team will continue to monitor your vital signs and watch for any emerging complications. Most complications that do emerge will do so in this time frame. They’ll also ask if you have any pain and treat it if necessary.

How serious is a liver biopsy?

A liver biopsy is a common and generally safe procedure when an experienced healthcare provider performs it. Serious complications are rare. The most common complications after the procedure are temporary pain and low blood pressure. The risk of life-threatening complications is estimated at 0.1%.

What are the possible risks or complications of liver biopsy?

Common complications include:

• Pain. Some people experience temporary pain after the procedure, in the region of their liver (upper abdominal pain) or radiating to their right shoulder. It’s usually mild and easily treated with medications. If it’s severe or longer lasting, it could be a sign of other complications.
• Low blood pressure. Some people experience a temporary drop in blood pressure after the procedure. You might feel a little light-headed. This is usually temporary and not cause for concern. If it drops a lot and you feel very weak or dizzy, it could be a sign of internal bleeding.

Rare but serious complications include:

• Internal bleeding.
• Infection.
• Bile leak.
• Pneumothorax.

How long is the recovery from a liver biopsy?

You’ll want to take it easy for about a week. Avoid rigorous exercise or lifting more than 10 to 15 pounds. The only aftercare is keeping your incision site clean while it heals. It may leave a tiny scar. Consult your provider about resuming your regular medications and treating any residual pain.

When will I have my biopsy results?

After your procedure, your liver tissue sample will go to a lab, where a pathologist will study it under a microscope. They’ll write a report explaining what they find. They’ll send this back to the healthcare provider who ordered it, and they’ll discuss the results with you. This might take a few days to a week.

When should I call my healthcare provider after a liver biopsy?

Contact your healthcare provider if you develop:

• Fever.
• Weakness or faintness.
• Difficulty breathing.
• Fast heart rate.
• Jaundice.
• Severe pain.
• Abdominal swelling.

A note from Cleveland Clinic

For most people, a liver biopsy is a brief and tolerable procedure. It’s a little more involved if it’s done through a vein, but the few additional steps are worthwhile to make the procedure safe for you. This test can give your healthcare provider crucial information about your condition and how to treat you.