Medical liver biopsy

A medical liver biopsy takes a small, thin piece of liver, usually about 2 cm long and 1 mm wide. Unlike a targeted liver biopsy, which aims at one spot, this biopsy samples ordinary liver tissue to see how the whole organ is doing.

Under the microscope, a pathologist can see how much fat is in the liver, how much inflammation there is and how much scarring has built up. Scarring is called fibrosis, and advanced scarring is called cirrhosis. The pathologist gives it a stage, usually from 0 (none) to 4 (cirrhosis).

What we see

Liver specialists (hepatologists) order this biopsy when blood tests and scans leave questions open. Common reasons include:

Today, many people can avoid a biopsy. Blood-based scores (such as FIB-4) and scans that measure liver stiffness, like FibroScan (transient elastography) or MR elastography, can estimate scarring without a needle. A biopsy is still the most complete test when those results are unclear, disagree with each other or when more than one liver disease is possible.

There are two ways to reach the liver. We choose based on your blood clotting, platelet count, whether there is fluid in your belly (ascites) and what your liver doctor needs to know.

Before a medical liver biopsy, I talk with your liver doctor about the exact question. If they also want to know the pressure in your liver, or your platelets are low, I usually recommend the neck approach. Either way, my aim is to get enough tissue on the first try, because a small sample can underestimate scarring.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Our general checklist is in before your procedure.

1. 1
   Getting ready

   At El Camino Hospital, a nurse starts an IV, connects monitors and gives moderate (twilight) sedation. For the side approach you lie on your back with your right arm over your head. For the neck approach your head turns gently to the left.

2. 2
   Numbing and access

   We use ultrasound to find a safe spot, then numb the skin. For the neck approach, a thin tube is guided through the jugular vein in the neck down to a liver vein, using X-ray and a little contrast dye.

3. 3
   Taking the samples

   We take 2 or 3 thin cores of liver. For the side approach you hold your breath for a few seconds each time. You may feel pressure or a brief ache in the right shoulder.

4. 4
   Finishing up

   We remove the needle or tube and close the skin with glue. For the neck approach, we may measure liver vein pressures first.

1. First 2–4 hours
   Rest in recovery while nurses check your blood pressure and the site. You can eat and drink.
2. Rest of the day
   Take it easy at home. No driving or alcohol after sedation. You can shower tonight.
3. Days 1–3
   Mild ache under the right ribs, in the right shoulder or in the neck is common. Most people are back at work the next day.
4. First week
   No heavy lifting, hard exercise, baths or swimming.

Liver tissue needs special stains, such as ones for scarring and iron, so results often take 3 to 7 days. They go to your liver doctor, who will explain your stage and what it means for treatment. Many liver conditions, including fatty liver, can improve with weight loss, treatment of hepatitis or stopping alcohol.

Use acetaminophen (Tylenol), no more than 2,000 mg a day if you have liver disease, unless your doctor gives a different limit. Avoid ibuprofen and naproxen for a few days.

Most people have only mild soreness. Pain needing extra medicine occurs in a minority of people and usually settles within a day. Serious bleeding is uncommon, roughly 1 in 200 to 1 in 100 people, and may need a transfusion or a procedure to seal the bleeding vessel. Rare risks include injury to the gallbladder, lung or bowel, infection and, for the neck approach, an irregular heartbeat while the tube passes through the heart, which stops when the tube moves on.

Sometimes the sample is too small for a confident stage, and a repeat biopsy is suggested.