Liver biopsy

A targeted liver biopsy takes small samples from one specific spot in the liver, called a lesion, that showed up on a CT, MRI or ultrasound. A pathologist then looks at the tissue under a microscope to find out what it is.

This page is about biopsy of a spot. If your doctor wants to look at the liver as a whole, for example to measure scarring from fatty liver or hepatitis, see medical liver biopsy.

Liver spots have many causes. Many are harmless, such as cysts, hemangiomas (a tangle of blood vessels) or focal nodular hyperplasia. Others are cancer that started in the liver, called hepatocellular carcinoma, or cancer that spread from elsewhere, such as the colon, breast, lung or pancreas. Sometimes a spot is an abscess, which is a pocket of infection.

Not always. Many harmless liver spots can be identified on a good MRI or CT and need no biopsy. In people with cirrhosis, primary liver cancer can often be diagnosed from a specialized MRI or CT alone. A biopsy is recommended when the scans cannot give a firm answer, or when your cancer doctors need tissue to choose treatment.

Other options include repeat imaging over a few months, a biopsy through an endoscope placed in the stomach (endoscopic ultrasound) for some spots in the left side of the liver, or surgery to remove the spot directly.

Our general checklist is in before your procedure.

1. 1
   Getting ready

   At El Camino Hospital, a nurse starts an IV and connects heart, blood pressure and oxygen monitors. You receive moderate (twilight) sedation. You usually lie on your back with your right arm above your head.

2. 2
   Finding the spot

   We scan the liver with ultrasound or CT to find the lesion and plan a path that avoids large blood vessels, the lung and the bowel. We numb the skin and the tissue down to the liver.

3. 3
   Taking the samples

   We guide a thin needle to the edge of the lesion and take 2 to 4 small cores. You will be asked to hold your breath briefly for each sample, because the liver moves as you breathe.

4. 4
   Finishing up

   We remove the needle, check the liver for bleeding with a final scan and close the puncture with skin glue.

What we see

With a liver spot, I look for the part of the lesion most likely to give an answer, often the living edge rather than a dead center. I also try to pass through a little normal liver on the way in, which helps seal the track. If the spot is small or hard to see, I tell you up front that it may take a bit longer.

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

1. First 2–4 hours
   Rest in recovery while nurses check your blood pressure and the puncture site. You can eat and drink, and family can sit with you.
2. Rest of the day
   Go home and take it easy. No driving, alcohol or important decisions after sedation. You can shower tonight.
3. Next 2–3 days
   Mild soreness under the right ribs or in the right shoulder is common. This shoulder pain is referred pain from the liver lining.
4. First week
   No heavy lifting, hard exercise, baths or swimming. Most people return to work and driving the next day.

Acetaminophen (Tylenol) is usually enough for pain. Ask us before taking ibuprofen or naproxen, as they can raise bleeding risk. Pain should ease each day, not get worse.

Results usually take about 2 business days and go to the doctor who referred you. If the tissue needs special stains, genetic testing or review by an outside expert, it can take a week or more.

Most targeted liver biopsies, around 9 in 10, give a clear diagnosis. If the sample is not enough, your team will discuss repeating the biopsy, trying another approach or surgery.

Bleeding is the main risk. Some bleeding around the liver happens in about 1 in 100 people, and it usually stops on its own. Rarely, a blood transfusion or a procedure to seal the bleeding artery (embolization) is needed. Signs include pain that grows, lightheadedness or a racing heart.

Other risks are uncommon: a sample that is not diagnostic, infection, injury to the gallbladder, lung or bowel, and, very rarely, cancer cells spreading along the needle track. We reduce these risks by planning the path carefully on the scan.