The liver biopsy procedure is performed to determine what is occurring in a patient's liver. The biopsy often helps to make a specific diagnosis when the cause of liver disease is unclear and also aids in determining the amount of liver damage for an individual patient.
A small piece of liver is removed (less than 1/5,000th of the liver) that does not affect liver function. The liver biopsy is currently the best way to determine the amount of liver damage but it is not perfect.
About 5-10% of the time, the liver biopsy underestimates the amount of inflammation or scar tissue. Less than 1% of the time does the liver biopsy overestimate the amount of damage to the liver. Your physician may wish to advise a liver biopsy 1 to 5 years in the future to confirm the original biopsy and to document progression or lack of progression regarding your chronic hepatitis C.
The biopsy is commonly preceded by an ultrasound examination (a device to visualize the liver using sound waves) of the liver to determine the best and safest biopsy site. Not all physicians order an ultrasound before the biopsy procedure. Intravenous sedation can be given at the patient's request (Valium or Versed). Sedation is used to make the patient relaxed but it is important to be partially awake so the breathing cycle can be held during the biopsy process.
The benefits of the liver biopsy may include the following:
(1) determining the severity of liver disease (inflammation),
(2) determining the amount of liver scar tissue (cirrhosis),
(3) change or finalize the diagnosis of the cause of liver disease if the blood tests and other assessments are confusing,
(4) allow a recommendation for treatment with interferon (for patients with hepatitis),
(5) you and your physician may wish to establish a screening process for liver cancer, if cirrhosis is found,
(6) determine if you have a medication induced liver disease.
The risks of the liver biopsy include:
(1) bleeding (1 in 500 patients),
(2) bleeding to such an extent that a patient may require transfusions or surgery (1 in 1000 patients),
(3) death (1 in 5000 patients),
(4) puncture of the lung, gallbladder, kidney or intestine (1 in 1000 patients),
(5) pain (1 in 5 patients).
The alternatives to the percutaneous liver biopsy include:
(1) no procedure,
(2) laparoscopic (insertion of a tube into the abdomen),
(3) surgical, with an opening of the abdomen,
(4) radiographic, either with CT scan, ultrasound or flouroscopy.
If pain occurs after the procedure, pain medication will be given orally or intravenously if there is no major changes in blood pressure or breathing patterns. You may be asked to stay in the hospital overnight if there are changes in your blood pressure or abdominal exam that suggest bleeding or another problem.
