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Liver Biopsy

By

Christina C. Lindenmeyer

, MD, Cleveland Clinic

Last full review/revision Dec 2019| Content last modified Dec 2019
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Liver biopsy provides histologic information about liver structure and evidence of liver injury (type and degree, any fibrosis Hepatic Fibrosis Hepatic fibrosis is overly exuberant wound healing in which excessive connective tissue builds up in the liver. The extracellular matrix is overproduced, degraded deficiently, or both. The trigger... read more ); this information can be essential not only to diagnosis but also to staging, prognosis, and management. Although only a small core of tissue is obtained, it is usually representative, even for focal lesions.

Percutaneous liver biopsy is usually done at the bedside with ultrasound guidance. Ultrasound guidance is preferred because its use provides the opportunity to visualize the liver and target focal lesions.

Indications

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Limitations of liver biopsy include

  • Sampling error

  • Occasional errors or uncertainty in cases of cholestasis

  • Need for a skilled histopathologist (some pathologists have little experience with needle specimens)

Contraindications

Absolute contraindications to liver biopsy include

  • Patient’s inability to remain still and to maintain brief expiration for the procedure

  • Suspected vascular lesion (eg, hemangioma)

  • Bleeding tendency (eg, international normalized ratio [INR] > 1.5)

  • Severe thrombocytopenia (< 50,000/microliter)

Relative contraindications include profound anemia, peritonitis, marked ascites Ascites Ascites is free fluid in the peritoneal cavity. The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Diagnosis is based on physical examination and... read more , high-grade biliary obstruction, and a subphrenic or right pleural infection or effusion. Nonetheless, percutaneous liver biopsy is sufficiently safe to be done on an outpatient basis. Associated mortality is about 0.01%. Major complications (eg, intra-abdominal hemorrhage, bile peritonitis, lacerated liver) develop in about 2% of patients. Complications usually become evident within 3 to 4 hours—the recommended period for monitoring patients.

Other routes

Transjugular venous biopsy of the liver is more invasive than the percutaneous route; it is reserved for patients with a severe coagulopathy, ascites Ascites Ascites is free fluid in the peritoneal cavity. The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Diagnosis is based on physical examination and... read more , and/or centripetal adiposity. The procedure involves cannulating the right internal jugular vein and passing a catheter through the inferior vena cava into the hepatic vein. A fine needle is then advanced through the hepatic vein into the liver. Biopsy is successful in > 95% of patients. Complication rate is low; 0.2% bleed from puncture of the liver capsule. This route allows for the simultaneous measurement of intra- and post-hepatic venous pressures, which can be useful in the elucidation of portal hypertension Portal Hypertension Portal hypertension is elevated pressure in the portal vein. It is caused most often by cirrhosis (in developed countries), schistosomiasis (in endemic areas), or hepatic vascular abnormalities... read more .

Occasionally, liver biopsy is done during surgery (eg, laparoscopy); a larger, more targeted tissue sample can then be obtained.

Drugs Mentioned In This Article

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OTREXUP
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