When is a liver biopsy performed and how is it done?

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

A liver biopsy is the removal of a small piece of tissue from an organ in order to establish or clarify a diagnosis. Its value lies in the fact that it is possible to accurately determine the cause of the disease and the stage of inflammation, as well as the level of damage.

There are several different types of procedures that differ in the extraction process.

Liver biopsy: what is it?

In medicine, the procedure is used widely and for almost all organs. In translation, the word "biopsy" means something like the following: consider living tissue. Doctors remove a small sample of tissue and it is sent to a laboratory where it is analyzed for viruses, bacteria, and malignant cells.

Examination of the liver is often performed, since the organ is susceptible to numerous diseases that are of a viral or inflammatory nature, as well as the appearance of malignant tumors.

When, after the ultrasound and tomography, there are doubts and it is necessary to clarify the diagnosis, then a liver biopsy is taken:

• If there are deviations in biochemical analyzes and the enzyme function is impaired;
• If there is a suspicion of cancer or metastases;
• With hepatitis, to determine its nature and cause;
• If there are congenital anomalies, as well as with jaundice, when it is impossible to establish its cause;
• With cirrhosis, as well as if complications arise as a result of an operation or organ transplant.

Contraindications must be taken into account before the procedure. You cannot conduct research if there is no access to the necessary tissues, the patient is not in a conscious state, or he has problems with the nervous system.

Contraindications include ascites, in which fluid usually accumulates in the abdominal cavity, as well as problems with blood coagulability and vascular permeability (this is observed in atherosclerosis, hypertension, varicose veins, etc.). Do not carry out the procedure if there is an allergy to anesthetic drugs, and there are also inflammatory and purulent organ pathologies. A biopsy study is never performed in case of a cancerous lesion of an organ, which is accompanied by uncompensated cirrhosis.

How is a liver biopsy performed?

To get accurate information, you need to prepare in advance for the procedure.

For this purpose, several basic rules must be taken into account:

• A week before the study, you should stop taking non-steroidal anti-inflammatory drugs. If anticoagulants are prescribed, then it is important to inform the doctor about this;
• In three days for a biopsy, it is necessary to exclude from the body products that provoke gas formation, for example, brown bread, milk, fresh fruits and vegetables. If you have problems with your digestive system, enzymes can be taken to avoid bloating. The amount must be prescribed by your doctor;
• On the eve of the procedure, it is important that the last meal takes place no later than nine in the evening, and the dinner should be light. Many doctors advise doing a cleansing enema;
• On the day of the biopsy, a complete blood count and clotting test are taken. They also conduct a control ultrasound to determine exactly where the puncture will be made;
• The procedure is performed only on an empty stomach.

Liver biopsy: how is it done?

Several techniques are used for carrying out and the final choice is made by the doctor and agreed with the patient.

Puncture biopsy of the liver. This option is used most often for hepatitis. It is less traumatic compared to other types of procedures. First, the skin where the puncture will be performed is treated with an antiseptic, and then local anesthesia is applied. It is important to breathe correctly during the procedure, which the doctor will definitely tell you about.

When the anesthesia works, the liver is punctured with a special needle. The doctor must do everything under the control of an ultrasound sensor, which is located next to the puncture site. With the help of an aspirator or a special pneumatic "pistol", the tissue sample is sucked in. After that, the needle is removed and the puncture site is covered with a bandage.

Incisional or intraoperative liver biopsy. The presented method is used during surgical intervention, for example, when removing a metastatic node or tumor. A distant education or a piece of tissue is sent for research. In situations where it is necessary to get an analysis urgently, then the surgeons cover the wound and wait for the result. In most cases, this tactic of action is chosen for cancer.

Laparoscopic liver biopsy. The analysis is taken during laparoscopic diagnosis or during laparoscopic surgery. The indications are the following situations: determination of the stage of tumor growth, peritoneal infection, unexplained hepatosplenomegaly, etc.

Laparoscopy is performed as follows: incisions are made in the abdomen, into which a fiberoptic probe with a camera, a lamp and instruments is inserted. Looking at the screen with the image, the liver is pierced, and then the required tissue sample is taken with forceps or a loop. Cauterization of blood vessels is also carried out.

Transvenous biopsy. This option is used in cases where intervention in the abdominal cavity is contraindicated, for example, in the presence of fluid or with a decrease in blood clotting. The procedure involves puncture of the jugular vein, through which a catheter is inserted into the hepatic vein under the control of a fluoroscope. A needle is inserted through it, which allows you to touch the liver and take a biopsy. During the procedure, the patient may feel pain in the right shoulder and at the puncture site.

Liver biopsy results

In medicine, several methods are used to assess the results of a study. Most often, doctors opt for the following options.

Metavir method. As a result of the analysis, the degree and stage of inflammation are established, for which points are assigned. If "0" is assigned, then there is no inflammatory process, and with "3" and "4" the situation is considered difficult and the inflammation is severe.

The stages of fibrosis are also scored on a 0 to 4 scale.

• 0 - no scars;
• 1 - scarring is minimal;
• 2 - scarring is present and it already affects not only the liver, but also other tissues;
• 3 - bridging fibrosis was found, in which the affected areas are connected to each other;
• 4 - deep scarring and cirrhosis.

Knodel method. This method is more complicated, but informative at the same time.

He also has a system of points that are combined into a single index.

• 0 - no inflammation;
• 1-4 - the inflammatory process is insignificant;
• 5-8 - inflammation is present, but it is small;
• 9-12 - the inflammatory process is considered moderate;
• 13-18 - the inflammatory process is significant.

It is important to note that biopsy results depend on the length of the tissue sample obtained and the volume of the fluid biopsy.

Liver biopsy: implications

The safety of the procedure depends on the qualifications of the specialist who performs it.

In most cases, the following complications occur:

• Painful sensations. The most common unpleasant consequence. Usually the pain is dull, not intense and goes away after a week. If the discomfort is strong, then it is allowed to use pain relievers;
• Bleeding. Another common complication associated with blood loss, and if serious, then transfusion is done. In some cases, surgery is required;
• Damage to other tissues. Such complications arise when using the blind method, when the needle accidentally damages the gallbladder, lungs and other organs and tissues;
• Infection. This complication is extremely rare and occurs when bacteria penetrate through the puncture.

Only the puncture type of procedure is performed on an outpatient basis, and in other situations, hospitalization is necessary. For 4-5 hours after the study, doctors should monitor the patient's condition. They also do an ultrasound scan, monitor blood pressure indicators and conduct an examination. If any abnormalities are not observed, then the patient is discharged. During the first day, it is necessary to give up driving a car and from taking medications that have an anti-inflammatory effect. Still, you should not be exposed to physical activity and avoid thermal procedures, for example, warming up, saunas and baths.

We have provided some basic information regarding a procedure such as a biopsy used to examine the liver.