Percutaneous Liver Biopsy

Microscopic or biochemical examination of liver tissue often provides the definitive diagnosis and leads to effective management of liver and systemic disorders. The liver tissue typically is obtained by percutaneous needle biopsy, either in hospitalized patients or in selected outpatients. The outpatient procedure is reserved for patients who do not have severe liver disease, a clotting disorder, or some other serious illness. Facilities must be available to observe the patients for 3 to 5 hours after the biopsy.

In recent years, percutaneous needle aspiration or biopsy of liver lesions under ultrasound or computed tomography (CT) scan guidance has obviated the need for obtaining a traditional “blind” liver biopsy in most patients. Automatic liver biopsy needles are used to obtain thin core biopsies of liver lesions or for sampling of the liver. Liver biopsy may also be obtained during laparoscopy.

I. INDICATIONS AND CONTRAINDICATIONS.

The major indication for performing a liver biopsy is to clarify the nature of suspected liver disease. In some instances, liver biopsy is performed to determine the effect of treatment of known liver disease or to document the appearance of the liver before initiating therapy (usually for a nonhepatic disorder) with a potentially hepatotoxic drug.

Contraindications to percutaneous liver biopsy are listed in Table 7-1; some may not be absolute. For example, patients with severe liver disease commonly have clotting disorders. If a liver biopsy is believed to be necessary under those circumstances, patients can be prepared with infusions of fresh-frozen plasma and platelets. In patients with severe liver disease and coagulopathy, a transjugular venous liver biopsy may be the safer and the only alternative technique for obtaining a liver biopsy.

II. TRADITIONAL METHOD OF PERFORMING THE BIOPSY

A. Prebiopsy care.

Patients should fast for at least 6 hours before the biopsy and, because they will have to remain in bed for several hours after the biopsy, they should be encouraged to void. Hemoglobin count, hematocrit, white blood cell count, platelet count, prothrombin time, and partial thromboplastin time should be determined several days before the biopsy.

B. Choice of biopsy site.

The patient lies in a supine position near the right edge of the bed with the right hand under the head and the head turned toward the left. If the liver is not enlarged, an intercostal site is chosen that is within the area of maximal liver dullness between the anterior and midaxillary lines. If the biopsy is being done under ultrasound, the site is chosen by the radiologist.

TABLE 7-1 Contraindications to Percutaneous Liver Biopsy

Uncooperative patient

Bleeding disorder

Infection in skin, pleura, right lower lung, or peritoneum overlying the liver

Suspected liver abscess or vascular lesion

Difficulty in determining liver location, as with ascites

Severe extrahepatic obstruction

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