Needle Biopsy of the Liver

Test Overview

A needle biopsy of the liver is a procedure to take a very small sample of your liver tissue. Then a doctor looks at this tissue under a microscope. He or she checks it for infection or other liver problems. This procedure is also called a percutaneous (say "per-kew-TAY-nee-us") procedure.

You will get medicine to help you relax. You will also get a shot of numbing medicine in the biopsy area. Then the doctor puts a long needle through your skin between two of your lower ribs on your right side. The needle goes into your liver to take the tissue sample. The doctor may use X-ray pictures on a screen to help guide the needle into the liver. When the needle goes into the liver, you may feel a pain in your shoulder. This is called referred pain. It's caused by pain that travels along a nerve near the biopsy area. After the doctor gets the sample, he or she removes the needle and puts a bandage on the spot where the needle went in. The procedure takes 15 to 20 minutes. But the needle is in your liver for just a few seconds.

After the procedure, you will need to lie on your right side for an hour or two. This can help stop bleeding in the part of your liver where the biopsy was done.

You will probably go home the same day. It can take several days to get the results of the biopsy. Your doctor will discuss the results with you.

Why It Is Done

A needle biopsy of the liver may be done to:

• Find the cause of jaundice. A liver biopsy can find certain liver diseases (such as cirrhosis), infections (such as hepatitis), and liver tumors.
• Find the cause of abnormal blood test results from aspartate aminotransferase (AST) and alanine aminotransferase (ALT) tests. Both ALT and AST levels show liver damage and can help confirm liver disease.
• See how much the liver is inflamed or scarred by hepatitis or other liver diseases.
• See whether other liver conditions, such as hemochromatosis and Wilson's disease, are present.
• Check the response to treatment for liver disease.
• Find out if a medicine, such as methotrexate, is causing a toxic effect on the liver.
• Check the function of a transplanted liver.
• Find the cause of an unexplained and ongoing fever.
• Check a liver mass found on an X-ray, ultrasound, MRI, or CT scan.

How To Prepare

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.

How It Is Done

A needle biopsy of the liver is done in a clinic or a hospital. When cirrhosis of the liver or a cancer is suspected, the biopsy may be done during a laparoscopy.

You will need to take off all or most of your clothes. You will be given a cloth or paper gown to use during the test.

Before the test, you may be given a sedative through a vein (I.V.) in your arm. The sedative will help you relax and stay still.

During the test

During the test, you will lie on your back with your right arm resting under or above your head and your head turned to your left. Your doctor may tap on your chest and belly to find your liver, or he or she may use ultrasound.

Your doctor will mark a spot between two of your right lower ribs where the biopsy needle will be inserted. The site will be cleaned with a special soap and draped with sterile towels. The doctor will give you a medicine (local anesthetic) to numb the area.

You may be asked to take a deep breath, blow all the air out, and then hold your breath while the biopsy needle is being inserted and withdrawn. This will take only a few seconds. Holding your breath lowers the chance that the needle will go in your lung since the lungs are very close to the liver. It is important to stay still during the few seconds it takes for the doctor to collect the tissue sample. The doctor may take another tissue sample from the same spot, but from a different angle.

As soon as the doctor removes the needle, you can breathe normally. A bandage will be put on the puncture site.

After the test

You will rest in bed and lie on your right side for 2 to 6 hours after the test. After the anesthetic wears off, you may feel a dull pain in your right shoulder.

You can go home if you have no problems after the test.

How long the test takes

The test generally takes 15 to 30 minutes.

How It Feels

You may feel a brief sting or burn when the numbing medicine (anesthetic) goes in your skin. When the biopsy needle is inserted, you may again feel a sharp pain for a few seconds. You may feel deep pressure and a dull pain in your belly while the biopsy needle is inserted.

Risks

Serious problems from a liver biopsy are rare. Problems can include:

• Bleeding, which may need blood transfusions or surgery to correct.
• A collapsed lung (pneumothorax).
• Injury to the intestines, gallbladder, or kidney.
• Infection in the belly (peritonitis).

Results

The tissue sample is sent to a lab and looked at under a microscope to see if there are any liver problems.

Test results are generally ready in 2 to 4 days. If tests are done to find infections, it may take several weeks for the results to be ready.

Liver biopsy

Normal:	The liver tissue looks normal under a microscope. No signs of infection, inflammation, cancer, or cirrhosis are present.
Abnormal:	Abnormal cells or liver tissue are present. This may be caused by an infection such as hepatitis, liver disease such as cirrhosis, or cancer. If liver cancer is present, the biopsy can help find the type of cancer. If hepatitis is present, the test can be used to see the chance of developing cirrhosis. Test results may also show the severity of cirrhosis.