Test Overview
Percutaneous liver biopsy is a procedure to take a very small sample of your liver tissue. Then a doctor looks at this tissue under a microscope. They check it for infection or other liver problems.
Percutaneous (say "per-kew-TAY-nee-us") means "through the skin." Sometimes this procedure is called aspiration biopsy or fine-needle aspiration.
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 medical imaging such as 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, they remove the needle and put 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 tumour.
- 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 cancelled. 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 and natural health products 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 aspirin or some other blood thinner, ask your doctor if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
- Make sure your doctor and the hospital have a copy of your advance care plan. 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 liver biopsy is done by a gastroenterologist, hepatologist, radiologist, or surgeon in a clinic or a hospital. A liver biopsy is often done by a radiologist using ultrasound or a fluoroscopy to help guide the biopsy needle. Liver biopsies may also be done during surgery such as 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 (IV) 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 they may use ultrasound.
Your doctor will mark a spot where the biopsy needle will be inserted. The area 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 where the biopsy needle will be inserted.
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 procedure site (the place where the needle went in). The test generally takes 15 to 30 minutes.
After the test
You will rest in bed for 2 to 6 hours after the test. After the anesthetic wears off, you may feel a dull pain in your right shoulder.
If you have no problems after the test, you can go home and rest for the day. Have a responsible adult take you home (do not drive yourself). If you live out of town, it’s a good idea for you to stay somewhere overnight within 1 hour of an emergency care hospital. Don’t drive for the next 24 hours or while you’re taking strong pain medicine.
You may eat your regular diet. If you have an upset stomach, try bland, low-fat foods such as toast, plain rice, and yogurt. Unless your doctor tells you it is okay, do not take aspirin, non-steroidal anti-inflammatory medicines, or blood thinners for 1 week after the biopsy. You may do your regular activities, but don't do hard activities or lift anything heavy (more than 4.5 kg or 10 lb.) for about 3 days or until your doctor says it is safe.
When you leave the hospital, you may have a dressing covering the procedure site. Leave the dressing on until the morning after the procedure, then change it (ask your healthcare provider how to change the dressing). It’s very important to keep the site clean and dry. You may shower 24 to 48 hours after the procedure. Don’t scrub the procedure site. Pat the site dry. Don’t take baths, use hot tubs, or go swimming until the procedure site no longer has a scab and is completely healed. Don't use any creams, lotions, or ointments on the procedure site.
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:
After the test
After the test, call 911 or other emergency services immediately if you develop:
- Signs of shock, such as passing out, or feeling very dizzy, weak, or less alert.
- Severe pain in your chest, shoulder, or belly.
- Moderate to severe trouble breathing.
- Bleeding from the procedure site that doesn't stop (for example, bright red blood has soaked through your dressing).
After the test, call your doctor or health link (call 811) immediately if you have:
- New bleeding from the procedure site.
- A fast or skipping heartbeat.
- Yellowing of your eyes or skin that is not normal for you.
- Pain, swelling, or bloating in your belly (abdomen) that is getting worse.
- Bruising or swelling at the procedure site that is getting bigger.
- Redness or warmth around the procedure site or drainage (fluid) from the procedure site.
- Trouble peeing or passing stool (poop).
- Stools (poops) that are black and tar-like or have streaks of blood.
- Pale-coloured stools (poops) along with dark urine and itching.
- An upset stomach and you can’t keep fluids down (you’re throwing them up).
- A fever over 38.5 ºC (101.3 ºF) or chills.
- Any other concerns.
Results
The tissue sample is sent to either a pathology or microbiology laboratory to be looked at.
- Samples of liver tissue sent to a pathology lab will be looked at under a microscope for liver diseases such as liver cancer or cirrhosis.
- Other samples of liver tissue may be sent to a microbiology lab to see whether an infection, such as tuberculosis of the liver, is present.
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. |
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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. |
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Credits
Adaptation Date: 2/24/2022
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
