Many of the tests we do for liver disease are “non-invasive” this includes blood tests and Fibroscans. These tests often give your doctor enough information to make a diagnosis of the cause and extent of your liver disease, however, in some cases further information is needed through biopsy samples.
A liver biopsy is a procedure where a small needle is passed into the liver to take a sample of liver tissue. This liver tissue is then sent to the pathology lab and examined by a specialist.
There are several reasons to perform a liver biopsy and your doctor will inform you of the reasons they feel a liver biopsy is required in your case. Some of the common reasons are to confirm the underlying cause for your liver disease, for example you may have several possible contributors to your liver disease and it is necessary to find out the main cause to decide on your further management. We may wish to confirm the stage of your liver disease and whether there is cirrhosis, especially if tests such as Fibroscan have not been possible. We may wish to assess your progress to treatment or take a sample from a specific area of abnormality in the liver.
You will have blood tests taken before the procedure, if the bleeding risk is too high your procedure may be rescheduled, this will be discussed with you.
If the procedure is felt to be safe to go ahead, you will be taken to the x-ray department and lie on your back. You will have a local anaesthetic injected into the skin on your right hand side. The Radiology (x-ray) doctor will then scan you with ultrasound or CT scan to identify the best area to biopsy. They will pass a needle into the area, using the ultrasound or CT scan to guide the needle to the best area. When the biopsy is being taken the needle will make a loud click. The doctor will often take more than one sample depending on what the biopsy is being performed for.
The biopsy procedure itself is very quick and painless due to the use of the local anaesthetic.
After the procedure you will need to lie on your right hand side for several hours and have your blood pressure and heart rate observed. This is to reduce the risk of bleeding after the procedure.
The liver has blood vessels and bile ducts running through it. Although your bloods are checked for bleeding risk before the procedure, and ultrasound or x-ray guidance is used throughout the procedure, we further reduce your risk by asking you to lie on your side after the procedure. Despite this there is still a risk that your blood vessels or bile ducts can be damaged. This can lead to bleeding or bile leak.
You will be given information on the risk of these complications in more detail by your doctor or the information booklet provided before the procedure. You will also be given the chance to discuss any specific concerns when you attend for the procedure.
The doctor undertaking the biopsy will send the tissue sample to the laboratory, where it will be looked at under a microscope by a specialist.
The report will be sent on to the doctor or nurse who requested your test, who will be able to interpret it along with the medical history, blood tests and any other results. No single test will diagnose the cause and extent of your liver disease.
In some cases we may not be able to get the required information the liver biopsy. In this instance the information will be passed onto the doctor or nurse who requested the test for them to decide the best next steps.
In most cases, as long as the sample is enough for analysis, a liver biopsy only needs to be done once.
In the past liver biopsies were used both to diagnose and monitor liver disease, however, in most cases monitoring of liver disease can be carried out using alternative methods such as a fibroscan.
There are instances when repeat biopsies are required, your doctor or specialist nurse will discuss this with you if needed.
Liver biopsies are invasive and can have complications, therefore they are only usually requested when the doctor or specialist nurse believes that this is the best test to do for your circumstances, however, it is your choice if you do not wish to have the test.
You should discuss alternative options with your doctor or nurse specialist, these may include blood test monitoring, regular Fibroscan or x-ray imaging. Alternative options will depend on the cause of your liver disease and the reason for performing the test.