Liver biopsy

Chapter 33 LIVER BIOPSY




KEY POINTS



• Liver biopsy is frequently performed to assist in the diagnosis and staging of liver disease.

• Since liver biopsy is an invasive procedure, the procedure requires appropriate precautions and informed consent.

• Safety warrants that patients should ideally have a normal (or close to normal) coagulation profile.

• Most biopsies are performed percutaneously with the assistance of hepatic ultrasound.

• The most serious complications include bleeding and haemobilia.

• Close monitoring of the blood pressure and pulse is required post procedure.

• For best histological interpretation the biopsy should ideally be at least 2 cm in length and contain at least six portal tracts.


INTRODUCTION


Liver biopsy remains an important tool in the investigation of hepatic dysfunction. It can obtain qualitative information regarding liver architecture, as well as type and degree of acute hepatic injury, and can both identify and qualify degree of fibrosis. A biopsy is usually performed after numerous non-invasive liver tests have been obtained.


It is also useful in evaluating and monitoring treatment of hepatic abnormalities and diseases, including post-transplant, and in guiding future management.



BIOPSY METHODS






Percutaneous

Most commonly used method, and safe when performed by an experienced operator. Use of ultrasound as a marker for needle entry improves safety.



Transjugular

A more invasive method, and most commonly used in patients with bleeding diatheses, or those with other conditions that would make percutaneous approach unsafe, such as morbid obesity or massive ascites, or after a failed attempt at percutaneous biopsy.



Laparoscopic

Invasive, and requires a surgical approach, and therefore general anaesthetic. Often performed in conjunction with another surgical procedure (e.g. cholecystectomy). Has an advantage over percutaneous biopsy in malignant hepatic lesions and in cirrhosis, and provides a higher diagnostic yield.



Ultrasound or CT-guided fine needle aspiration

Obtains only a small number of cells, and is used mainly to target specific liver lesions, rather than sample a homogeneous liver.



Indications



• Grading and staging of chronic hepatitis B.

• Grading and staging of chronic hepatitis C in genotype 1, or hepatitis B and C coinfection.

• Diagnosis of abnormal liver tests, usually after at least 6 months of inconclusive serological tests.

• Diagnosis of non-alcoholic steatohepatitis (NASH), autoimmune hepatitis and alcoholic liver disease.

• Diagnosis of haemochromatosis with ferritin >1000 μg/L and Wilson’s disease.

• Primary biliary cirrhosis and sclerosing cholangitis.

• Evaluation of liver function post-transplant, and to assess potential donor.

• Assessment of drug effects on the liver (e.g. long-term methotrexate therapy).

• Diagnosis of a liver lesion.

• Pyrexia of unknown origin.

Histology is not needed prior to therapy for hepatitis C in some centres, therefore biopsy is not always necessary. Biopsy may stage the disease satisfactorily, but is not good for predicting clinical response to treatment.


Percutaneous biopsy of a neoplastic lesion has the small potential for seeding, and is therefore not usually performed. A lesion >2 cm with a high alpha-fetoprotein (AFP) in serum is highly sensitive for malignancy.


Biopsy is the only method of assessing fibrosis in NASH (see Chapter 39). Patients with a BMI >30 kg/m2, diabetes or age >45 years should be biopsied. Up to 20% of NASH patients will have severe fibrosis.


Diagnosis of viral hepatitis or NAFLD does not require biopsy.


At least six portal tracts are needed for accurate diagnosis. Specimen should be at least 2 cm in length.

Related posts:

Chronic pancreatitis Colorectal cancer screening Practical issues in nutrition and supplementation in gastrointestinal disease The hepatitis C-positive patient Pregnancy and liver disease Obesity surgery

Stay updated, free articles. Join our Telegram channel
Tags:
Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Liver biopsy

Full access? Get Clinical Tree
Get Clinical Tree app for offline access