Liver biopsy

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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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.
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