A liver biopsy is a procedure in which a small tissue sample from the liver is collected.
Why are liver biopsies done?
Patients with pre-existing liver problems, especially patients with a history of Hepatitis B or C, may have experienced serious liver damage that could influence what chemotherapy drugs are safe to give or, in fact, whether any are safe. In many cases, the only reliable way to assess liver damage is to take a tissue sample, or biopsy, from the liver itself.
Liver damage can occur as a result of various drugs, especially high-dose chemoradiotherapy, and is also a common problem in patients with graft-versus-host disease. In order to determine a diagnosis and to decide on a treatment strategy, a tissue sample from the liver may be required.
You should not eat or drink after midnight the day before the liver biopsy. Testing will be done to ensure that you will have adequate platelet counts and clotting factor levels to prevent bleeding after the biopsy. If necessary, platelets and/or plasma will be given before the procedure.
There are two techniques for performing a liver biopsy, and both will be explained to you by the physician in detail before you are asked to sign a consent form.
A percutaneous biopsy. This kind of liver biopsy is done using the ultrasound machine to guide a needle between the lower ribs on the right front of the chest and into the liver itself. A local anaesthetic or freezing agent is used to make this insertion as painless as possible. While the liver is not pain-sensitive, the lining around it is. You may feel discomfort in the right side of the abdomen or the right shoulder for a short time afterwards. The procedure takes about 20 minutes at the Ultrasound Department.
A transvenous biopsy. When patients have low platelet counts or serious clotting factor deficiencies, a transvenous biopsy is preferred because of a lower risk of blood loss. This procedure is performed in the Vascular Radiology Department. The patient is first placed under local anaesthetic. The procedure involves placing a long biopsy wire in a large vein in the neck or groin, and advancing it into the veins within the liver itself. The wire is then passed through the wall of the vein, and a piece of liver tissue is drawn back into the vein and gradually pulled out. This procedure is not usually associated with much discomfort beyond that associated with the freezing and the initial insertion of the needle.
Regardless of which biopsy technique is used, you are closely monitored for the first few hours afterwards for any sign of bleeding from the biopsy site. This complication is serious but rare. It might be manifested by increasing abdominal pain, a fall in blood pressure, or blood hemoglobin level, or a rise in heart rate.
After the Procedure
You will need to arrange for someone to take you home from the hospital since you should not drive after having the sedative. Avoid exertion for the next week so that the liver can heal. Follow the doctor’s instructions for resting and recovery.