A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease. Your doctor may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem. A liver biopsy is also used to determine the severity of liver disease. This information helps guide treatment decisions.
The most common type of liver biopsy is called percutaneous liver biopsy. It involves inserting a thin needle through your abdomen into the liver and removing a small piece of tissue. Two other types of liver biopsy — one using a vein in the neck (transjugular) and the other using a small abdominal incision (laparoscopic) — also remove liver tissue with a needle.
A liver biopsy is a safe procedure when performed by an experienced doctor. Possible risks include:
- Pain. Pain at the biopsy site is the most common complication after a liver biopsy. Pain after a liver biopsy is usually a mild discomfort. If pain makes you uncomfortable, you may be given a narcotic pain medication, such as acetaminophen with codeine (Tylenol with Codeine).
- Bleeding. Bleeding can occur after a liver biopsy. Excessive bleeding may require you to be hospitalized for a blood transfusion or surgery to stop the bleeding.
- Infection. Rarely, bacteria may enter the abdominal cavity or bloodstream.
- Accidental injury to a nearby organ. In rare instances, the needle may stick another internal organ, such as the gallbladder or a lung, during a liver biopsy.
In a transjugular procedure, a thin tube is inserted through a large vein in your neck and passed down into the vein that runs through your liver. If you have a transjugular liver biopsy, other infrequent risks include:
- Collection of blood (hematoma) in the neck. Blood may pool around the site where the catheter was inserted, potentially causing pain and swelling.
- Temporary problems with the facial nerves. Rarely, the transjugular procedure can injure nerves and affect the face and eyes, causing short-term problems, such as a drooping eyelid.
- Temporary voice problems. You may be hoarse, have a weak voice or lose your voice for a short time.
- Puncture of the lung. If the needle accidentally sticks your lung, the result may be a collapsed lung (pneumothorax).
Why a Liver Biopsy Is Performed
Your doctor may order a biopsy to help determine if an area is infected, inflamed, or cancerous. Symptoms that a doctor would test for include:
- digestive system issues
- persistent abdominal pain
- right upper quadrant abdominal mass
- laboratory tests pointing to the liver as an area of concern
A liver biopsy is usually done if you received abnormal results from other liver tests, have a tumor or mass on your liver, or suffer from consistent, unexplainable fevers.
While imaging tests like CT scans and X-rays can help identify areas of concern, they can’t differentiate between cancerous and noncancerous cells. For this, you need a biopsy.
Although biopsies are typically associated with cancer, it doesn’t mean you have cancer if your doctor orders this test. Biopsies also allow doctors to see if a condition other than cancer is causing your symptoms.
A liver biopsy can be used to diagnose or monitor a number of liver disorders. Some conditions that affect the liver and may require a biopsy include:
- alcoholic liver disease
- autoimmune hepatitis
- chronic hepatitis (B or C)
- hemochromatosis (too much iron in the blood)
- nonalcoholic fatty liver disease (FLD)
- primary biliary cirrhosis (which leads to scarring on the liver)
- primary sclerosing cholangitis (which affects the liver’s bile ducts)
- Wilson’s disease (an inherited and degenerative liver disease caused by excess copper in the body)