Liver Biopsy – When is it recommended, and how is the examination performed?

The liver biopsy is a medical procedure used to obtain samples of liver tissue, and it is now considered a common routine intervention. During the procedure, a tissue cylinder is obtained from the liver tissue or from lesions observed in the liver, which is then sent for histological examination. The sampling is typically guided by imaging techniques such as ultrasound or CT, ensuring accurate localization.

The purpose of the liver biopsy is to enable the diagnosis of liver diseases, especially when other tests do not provide clear answers regarding the causes of the disease. Through histological examination, the type and severity of the disease can be determined, which can assist in developing an appropriate treatment plan. However, the procedure is invasive and is only recommended when other methods do not provide sufficient information.

Although the liver biopsy is a useful tool for establishing a diagnosis, it is not recommended in all cases. There are several contraindications that must be considered before the procedure. If the liver biopsy is performed under appropriate conditions, the risk of complications can be minimized.

When is a liver biopsy necessary?

A liver biopsy becomes justified when the diagnosis of liver diseases cannot be established by other methods, such as laboratory or imaging tests. In some cases, it may not be possible to clearly define the patient’s condition, such as in cases of autoimmune hepatitis or various storage diseases. In such situations, histological examination can confirm suspicions and assist in planning further treatments.

The aim of the liver biopsy is to clarify the origin and severity of the disease. Histological analysis not only aids in diagnosis but also helps in understanding the progression of the disease. With an accurate diagnosis, the treating physician can recommend more effective and targeted therapy, which can improve the patient’s condition.

It is important to note that the liver biopsy is an invasive procedure, so thorough consideration is necessary before making a decision. Doctors take into account the patient’s overall condition, previously performed tests, and potential risks.

When is a liver biopsy not recommended?

Before performing a liver biopsy, the specialist must consider possible contraindications. In cases where the patient’s coagulation parameters are abnormally prolonged, the procedure may be risky as it increases the likelihood of bleeding. A similar situation arises if the patient is taking anticoagulants or antiplatelet aggregation medications that were not discontinued before the examination.

Additional contraindications for the procedure include the presence of significant amounts of fluid in the abdominal cavity or if the lesions in the liver are not safely accessible. Patients who cannot lie flat—such as those with respiratory difficulties—are also not suitable for the examination. Finally, if the histological findings do not affect the patient’s treatment, performing the biopsy may be unnecessary.

The process of liver biopsy

The liver biopsy is usually performed under ultrasound guidance, as this method is more accessible and carries fewer risks than CT-guided biopsy. Before the examination, the patient must lie flat, and the skin surface must be disinfected before the procedure. Local anesthesia of the skin is optional, as liver tissue is insensate, so the patient typically does not feel pain during the sampling.

During the biopsy, the patient needs to take a deep breath, and the sampling occurs during a breath hold. The tissue cylinder is placed in formalin, and the patient is then taken to the inpatient ward. The entire procedure takes about half an hour.

After the liver biopsy, the patient must rest for at least four hours and can only perform limited movements in bed. Fluid intake is allowed, while solid foods can be consumed for dinner. During observation, blood pressure is continuously monitored, and pain relief can be requested if necessary. If no complications are observed during monitoring, the patient can go home the next day.

Possible complications

Although the liver biopsy is generally a safe procedure, like any invasive intervention, it can have complications. One of the most common complications is bleeding; however, if contraindications are not present, the likelihood of this is minimal. Continuous monitoring of blood pressure and blood counts can reduce the risk of hidden bleeding.

A hematoma may also develop at the site of the puncture, but very rarely, other organs may be punctured during the sampling. In cases of lack of sterility, secondary infections can occur, leading to complications.

After the procedure, patients may experience temporary pain, but this is generally not considered a complication. However, if the pain persists or worsens, it is important for the patient to inform their doctor about their complaints. After the liver biopsy, histological results are usually available within 7-10 days, which can assist in planning further treatments.