A thin needle is used to extract a tissue sample from the liver, and this specimen is sent to a laboratory for analysis. A liver biopsy may be performed to obtain a specimen from a particular area of the liver that appears altered due to disease (focal defect), or to obtain a representative sample of tissue in order to diagnose disease that is present throughout the liver.
Purpose of the Liver Biopsy
- To monitor the condition of the liver and diagnose or confirm the presence of liver disease, such as hepatitis, damage to the liver due to drugs, or cirrhosis
- To distinguish between benign or malignant (cancerous) tumors that were detected on an imaging test, such as a CT scan
- To determine the cause of unexplained liver enlargement, jaundice (yellowing of the skin), or persistently elevated liver enzyme levels when less invasive tests have proven inconclusive.
- To look for other liver conditions such as cancer, fat buildup (steatosis), iron buildup (hemochromatosis) and infections
- To help make decisions about the best course of treatment for liver conditions
- To determine a starting point (baseline) for future biopsies to track liver scarring.
Who Performs Liver Biopsy
- A gastroenterologist or a radiologist
Special Concerns about Liver Biopsy
- This procedure is not appropriate for people with infections near the biopsy site (such as in the lung), jaundice caused by a bile duct obstruction, or ascites (excess fluid in the abdomen); those who have difficulty remaining still and holding their breath; some people with anemia; and some patients with bleeding disorders.
- Blood coagulation studies are needed before the biopsy is done to ensure it can be performed safely.
- Obtaining the tissue sample may be difficult in obese patients.
- Rarely, a liver biopsy may be performed via laparoscopy rather than needle biopsy.
Before the Liver Biopsy
- Tell your doctor if you regularly take medications including anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen), blood thinners, high blood pressure medicine, diabetes medicine, antidepressants, antibiotics, asthma medications or dietary supplements. You will be instructed to discontinue them for some time before the test. Also mention any herbs or supplements that you take.
- Do not eat or drink anything after midnight on the day before the test.
- If needed, your doctor may give you a sedative injection to reduce anxiety.
- Tell your doctor if you have bleeding problems or disorders or drug allergies or sensitivities
- Tell your doctor if you are pregnant or may be pregnant
- Empty your bladder before the test.
- You will be asked to disrobe above the waist and put on a hospital gown.
What You Experience
- You will lie down on your back with your right hand behind your head.
- The skin above the liver is cleansed with antiseptic, and a local anesthetic is injected to numb the area. (You may still experience some discomfort when the biopsy is taken.)
- The doctor will ask you to exhale completely and hold your breath. (You may practice this several times.)
- While you are holding your breath, the doctor quickly inserts the biopsy needle through the chest wall into the liver and withdraws a thin core of tissue; this takes about 1 second.
- In many cases, ultrasound imaging, CT scanning, or MRI is used to guide placement of the needle in order to precisely target a specific lesion.
- Pressure is placed on the biopsy site until bleeding has stopped, and a small bandage is applied.
- The procedure usually takes about 10 to 15 minutes.
Risks and Complications of Liver Biopsy
- Possible serious complications include bleeding, infection (peritonitis) caused by inadvertent puncture of a bile duct and subsequent bile leakage, and pneumothorax (leakage of air outside the lungs and into the pleural cavity, resulting in a collapsed lung) due to improper needle placement in the chest cavity.
After the Liver Biopsy
- You will lie on your right side in a recovery area for 1 to 2 hours after the procedure. (This compresses the liver against the chest wall, reducing the risk of bleeding or bile leakage.) You may be instructed to place a small pillow under your side during this period to provide additional pressure. During this time, your blood pressure, heart rate, breathing, pain level will be monitored as well as your level of pain and you will be observed for signs of complications.
- Drink only clear fluids (such as water or apple juice) for the first several hours. After this period, you may resume your regular diet.
- You may be given pain-relieving medication to allay any discomfort around the biopsy site.
- Arrange for a ride home.
- You should rest in bed for up to 24 hours.
- Avoid aspirin or ibuprofen, which can increase bleeding problems, for one week after a biopsy.
- Avoid exercise and strenuous physical activity for one week to allow the spot where the needle was inserted, and the liver to heal.
- The tissue sample is sent to a pathology laboratory and examined under a microscope for abnormalities such as scarring (cirrhosis), inflammation (hepatitis), or tumors.
- This test usually results in a definitive diagnosis. Treatment will be initiated, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media