Liver Biopsy

A liver biopsy is a procedure performed to diagnose liver diseases and observe the course of the disease. If specialists suspect liver damage as a result of tests such as liver function tests, they may decide to perform a biopsy to confirm the diagnosis.

What is a Liver Biopsy and What is it Used For?

A liver biopsy is the process of taking a small tissue sample from the liver to be examined under a microscope to diagnose liver diseases or assess the stage of the disease. The biopsy can be performed using different methods such as fine needle aspiration (percutaneous biopsy), transvenous liver biopsy, or surgical biopsy, and plays an important role in the diagnosis, treatment, and follow-up of liver diseases.

In patients presenting to healthcare institutions with complaints such as persistent abdominal pain, digestive issues, jaundice, and unexplained weight loss, the cause of symptoms is primarily investigated through blood and urine tests. In diagnosing liver diseases, evaluating liver enzymes such as alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) through blood tests is crucial. High levels of these enzymes in blood tests may indicate a temporary liver disease or a more serious health issue such as chronic hepatitis or liver failure. Additionally, imaging methods such as ultrasound and MRI can reveal abnormalities like fibrous tissue in the liver, leading specialists to suspect diseases such as cirrhosis or liver cancer. Accordingly, the main purposes of specialists in performing a liver biopsy are as follows:

• To diagnose a liver disease that cannot be confirmed by blood tests or imaging methods,
• To obtain tissue samples from abnormal formations such as tumors detected in the liver through imaging methods like ultrasound or MRI,
• To determine the stage of liver disease,
• To plan the treatment process,
• To evaluate the health of the liver in patients who have undergone liver transplantation.

In addition to the above, a liver biopsy can also be performed to assess the response of the disease to treatment. For example, in diseases like autoimmune hepatitis, if treatment is stopped despite active disease findings, the risk of relapse is high. The biopsy procedure can help determine how much longer treatment should continue.

What Diseases is a Liver Biopsy Used to Diagnose?

A liver biopsy can be performed when the tests conducted are insufficient to confirm the diagnosis, to verify or eliminate suspicion. Additionally, specialists may resort to biopsy to assess the course of the disease by determining the stage of the disease in chronic liver disease patients. Accordingly, the main health issues for which a liver biopsy can be performed are as follows:

• Alcohol-related fatty liver disease,
• Non-alcoholic fatty liver disease,
• Types of liver cancer such as hepatocellular carcinoma,
• Autoimmune hepatitis,
• Chronic hepatitis B or chronic hepatitis C,
• Hemochromatosis characterized by high iron absorption,
• Cirrhosis, which is characterized by the replacement of healthy liver tissue with fibrous (scar) tissue,
• Unexplained elevation of liver enzymes,
• Primary biliary cholangitis,
• Wilson’s disease.

As can be understood from the above, a liver biopsy is not merely a medical procedure sought to diagnose cancer or cirrhosis, contrary to popular belief. Specialists may resort to biopsy in the diagnosis, treatment, and follow-up of many liver diseases.

Who is a Liver Biopsy Performed On?

A liver biopsy can be performed on patients whose symptoms and tests indicate liver disease. Additionally, a biopsy may be performed to evaluate how the disease responds to treatment in patients diagnosed with liver disease. The main situations in which specialists may recommend a liver biopsy are as follows:

• Patients diagnosed with hepatomegaly, also known as liver enlargement, as a result of tests,
• Those with jaundice in their skin and eyes,
• Patients with abnormal results in blood tests suggesting liver disease,
• Those undergoing treatment for liver disease,
• Patients who have undergone liver transplantation.

The values obtained from the liver biopsy help confirm the diagnosis, differentiate from other diseases, and plan the treatment process in the presence of symptoms indicating liver disease as mentioned above.

How is a Liver Biopsy Performed?

Specialist physicians conduct a detailed examination of the patient before the biopsy. If blood tests reveal clotting issues, certain medications may be prescribed before the procedure to minimize the risk of bleeding during the biopsy. A liver biopsy can be performed using various techniques. The main types of liver biopsy are as follows:

• Percutaneous liver biopsy: Also known as needle biopsy, percutaneous biopsy is usually performed under the guidance of imaging methods such as ultrasound. During the procedure, the patient is comfortably laid on their back, with their right arm placed under their head. The specialist doctor typically marks an area between the 6th and 9th ribs. At this stage, the surrounding tissue and organs of the liver are also checked with ultrasound. Once the doctor is sure that the marked area is correct, local anesthesia is applied to ensure the patient does not feel any discomfort. While the patient is under the effect of local anesthesia, a small incision is made in line with the marked ribs, and the liver biopsy needle is carefully directed to the liver, taking care not to damage the vessels. Patients may be asked to hold their breath as the needle quickly enters and exits the liver to obtain a tissue sample. Nowadays, percutaneous biopsy can be performed using various needles such as suction needles, cutting needles (Tru-cut and Vim-Silverman), and spring-loaded cutting needles. Each needle has its own advantages and disadvantages. For example, suction needles provide more tissue sampling opportunities but may damage the liver in cirrhotic patients. In contrast, during liver Tru-cut biopsy, less tissue may be obtained, but the liver is not harmed.
• Transvenous biopsy: Transvenous biopsy is usually performed on individuals with clotting issues, patients with fluid accumulation in the abdomen, or obese patients where percutaneous biopsy may be considered risky. In this method, instead of entering between the ribs with a needle, access is gained to the liver through a vein (usually from the neck or groin). During the procedure, the area where the biopsy will be performed is first anesthetized. Then, a catheter is placed through a vein in the neck or groin. Subsequently, using a imaging method called fluoroscopy, the catheter is directed to a vein in the liver. Once specialists reach the liver, they pass a biopsy needle through the catheter to take a sample.
• Laparoscopic biopsy: In some patients, during abdominal surgeries performed for other purposes, specialists may take a tissue sample from the liver to evaluate its health. Additionally, laparoscopic liver biopsy may be applied in cases where percutaneous biopsy or transvenous biopsy is insufficient. Unlike other methods, laparoscopic biopsy is usually performed with the assistance of general anesthesia. While the patient is under the effect of general anesthesia, specialist doctors make one or more small incisions in the abdomen, reach the liver with a device called a laparoscope through the incisions, and take a tissue sample. After obtaining the tissue sample, the incisions are closed with stitches.

The tissue sample obtained through the techniques mentioned above is prepared after being examined in the laboratory. After detailed examination by specialist pathologists under a microscope, the liver biopsy result is typically ready within an average of 1 week.

What Should the Patient’s Preparation Process Be Before a Liver Biopsy?

To minimize the risk of complications such as pain and bleeding after a liver biopsy, the patient should have a detailed discussion with their doctor, sharing their medical history, medications they are taking, and any chronic diseases they may have. It is particularly important for patients using blood-thinning medications or dietary supplements that may affect clotting to inform their doctors about this.

Patients are generally advised not to eat or drink anything 6-8 hours before the biopsy procedure. In some cases, a light breakfast may be allowed. Additionally, on the day of the procedure, it is recommended that the patient wear comfortable clothing to feel more at ease. Although the biopsy is usually performed under local anesthesia, sedation may also be applied in some cases. Therefore, it may be beneficial for the patient to come with an escort.

Frequently Asked Questions

The side effects after a liver biopsy are negligible when performed by specialist physicians. Many liver diseases can be definitively diagnosed and the treatment process can be planned through biopsy. If you have persistent abdominal pain, digestive issues, jaundice, or similar complaints, do not hesitate to make an appointment with a specialist doctor for necessary checks.