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A liver specimen can be obtained during exploratory surgery but is more often obtained by inserting a hollow needle through the skin and into the liver. Before this procedure, called percutaneous liver biopsy, is performed, the skin is anesthetized. Ultrasound is usually used to locate the liver and guide the needle to biopsy any abnormal area. Liver biopsy can be performed as an outpatient procedure. After the specimen is obtained, the person remains in the outpatient department for 3 to 4 hours because of a small risk of complications, such as tearing (laceration) of the liver. If the liver is torn, bleeding into the abdomen may occur, which, if severe, can lead to shock. Because bleeding can start up to 15 days after the biopsy, the person is instructed to stay within an hour's drive of the hospital during that period. These complications, though infrequent, can cause serious problems; 1 of 10,000 people die as a result of the procedure. Mild pain in the upper right abdomen, sometimes extending to the right shoulder, is common after a liver biopsy and is usually relieved by analgesics.
In transvenous liver biopsy, a catheter is inserted into a neck vein, threaded through the heart, and placed into one of the hepatic veins that drain the liver. A needle on the tip of the catheter is then inserted through the wall of the vein into the liver. This procedure is less likely to injure the liver than is percutaneous liver biopsy. It is especially useful in people who bleed easily, a complication of severe liver disease.
Liver biopsy can detect information about the liver that may not be evident from other tests. It is commonly used to detect excess fat in the liver (fatty liver), chronic liver inflammation (chronic hepatitis), metabolic liver diseases such as Wilson's disease (an excess of copper) and hemochromatosis (iron overload), complications following liver transplantation, and cancer that has spread to the liver.
Last full review/revision October 2006 by Eldon A. Shaffer, MD
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