eMedicine Specialties > Clinical Procedures > Gastrointestinal Procedures

Percutaneous Liver Biopsy

Author: Gaurav Arora, MD, MS, Fellow in Gastroenterology and Hepatology, University of Texas Medical School at Houston and MD Anderson Cancer Center; Former Advanced Hepatology Fellow, Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine
Coauthor(s): Walid S Ayoub, MD, Clinical Assistant Professor of Medicine, Division of Gastroenterology and Hepatology and Liver Transplant Program, Stanford University School of Medicine; Emmet B Keeffe, MD, MACP, Professor of Medicine Emeritus, Stanford University Medical Center
Contributor Information and Disclosures

Updated: Apr 5, 2009

Introduction

Percutaneous liver biopsy is a procedure in which a long needle is introduced through the skin, subcutaneous tissues, intercostal muscles, and peritoneum into the liver to obtain a specimen of liver tissue.1,2 This procedure is usually performed on an outpatient basis. The patient is then observed for a few hours in the hospital or the ambulatory unit.

The liver biopsy needle used can be one of the following 3 types:

  • Cutting needle
  • Suction needle (discussed in this article)
  • Spring-loaded needle
This topic focuses on the technical aspects of performing a percutaneous liver biopsy. For a more detailed discussion of the theoretical aspects, please see Diagnostic Liver Biopsy.

Indications

Initial diagnosis3

  • Evaluation of abnormal liver test results, if all other workup is unrevealing
  • Determination of stage of fibrosis and grade of inflammation for chronic hepatitis B and hepatitis C4
  • Evaluation of autoimmune hepatitis
  • Evaluation of a liver mass that does not exhibit typical imaging features of hepatocellular carcinoma (HCC)
  • Quantitative estimation of iron in hemochromatosis
  • Quantitative estimation of copper in Wilson disease
  • Estimation of the severity of alcoholic liver disease
  • Evaluation of drug toxicity
  • Evaluation of the suitability of a donor liver for transplantation
  • Diagnosis and staging of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)
  • Evaluation of unexplained jaundice
  • Diagnosis of cholestatic liver disease
  • Evaluation of infiltrative or granulomatous disorders
  • Evaluation of liver injury from immunosuppressive agents (methotrexate)
Surveillance during treatment
  • Follow-up evaluation while on antiviral treatment for chronic hepatitis C (rare)
  • Monitoring of disease activity of autoimmune hepatitis during treatment (may assist in determining if therapy can be discontinued)
Posttransplant (liver)
  • Diagnosis of acute cellular rejection
  • Diagnosis of chronic rejection
  • Diagnosis of recurrent hepatitis C
  • Diagnosis of posttransplant lymphoproliferative disorder
  • Diagnosis of cytomegalovirus (CMV) hepatitis
  • Protocol biopsies to monitor for fibrosis or inflammation (particularly in patients who received liver transplants to treat liver failure in chronic hepatitis C)

Contraindications

  • Uncooperative patient5
  • Inability to identify a suitable biopsy site by either percussion or ultrasonographic guidance
  • Prolonged (>1.5) international normalized ratio (INR)6
  • Decreased platelet count (<60,000/mm3)
  • Bleeding diathesis (eg, hemophilia)
  • Recent use (within the last 7 days) of aspirin or nonsteroidal anti-inflammatory drugs (NSAID) or antiplatelet class of medications
  • Unavailability of blood products for transfusion
  • Morbid obesity of patient
  • Ascites
  • No backup support available from surgery or interventional radiology in case of a complication
  • Suspected hemangioma or hepatic echinococcal cysts
  • Abdominal wall infection over the identified biopsy site
  • Infection in the right pleural cavity or below the right hemidiaphragm
  • Bowel overlying biopsy site (on ultrasound or other abdominal imaging)

More on Percutaneous Liver Biopsy

Overview: Percutaneous Liver Biopsy
Treatment & Medication: Percutaneous Liver Biopsy
Multimedia: Percutaneous Liver Biopsy
References
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References

  1. Karamshi M. Performing a percutaneous liver biopsy in parenchymal liver diseases. Br J Nurs. Jun 26-Jul 9 2008;17(12):746-52. [Medline].

  2. Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int. May 2008;28(5):705-12. [Medline].

  3. Gilmore IT, Burroughs A, Murray-Lyon IM, Williams R, Jenkins D, Hopkins A. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut. Mar 1995;36(3):437-41. [Medline].

  4. Sporea I, Popescu A, Sirli R. Why, who and how should perform liver biopsy in chronic liver diseases. World J Gastroenterol. Jun 7 2008;14(21):3396-402. [Medline].

  5. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. Feb 15 2001;344(7):495-500. [Medline].

  6. Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. Gut. Oct 1999;45 Suppl 4:IV1-IV11. [Medline].

  7. Caturelli E, Giacobbe A, Facciorusso D, Bisceglia M, Villani MR, Siena DA, et al. Percutaneous biopsy in diffuse liver disease: increasing diagnostic yield and decreasing complication rate by routine ultrasound assessment of puncture site. Am J Gastroenterol. Jul 1996;91(7):1318-21. [Medline].

  8. Howard R, Karageorge G, van Harselaar K, Bell M, Basford P, Schultz M, et al. Post-procedure surveillance in liver biopsy: how long is long enough?. N Z Med J. Aug 22 2008;121(1280):8-14. [Medline].

  9. Firpi RJ, Soldevila-Pico C, Abdelmalek MF, Morelli G, Judah J, Nelson DR. Short recovery time after percutaneous liver biopsy: should we change our current practices?. Clin Gastroenterol Hepatol. Sep 2005;3(9):926-9. [Medline].

  10. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology. Nov 1990;99(5):1396-400. [Medline].

  11. Froehlich F, Lamy O, Fried M, Gonvers JJ. Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci. Aug 1993;38(8):1480-4. [Medline].

  12. Orlando G, Goffette P, Gravante G, Ciccarelli O, Lerut J. Successful treatment of haemothorax following percutaneous liver biopsy using interventional radiology: importance of arterial anatomical variations. Transpl Int. Jul 2008;21(7):708-10. [Medline].

  13. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol. 1986;2(2):165-73. [Medline].

  14. Garcia-Tsao G, Boyer JL. Outpatient liver biopsy: how safe is it?. Ann Intern Med. Jan 15 1993;118(2):150-3. [Medline].

  15. Jacobs WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Dig Dis Sci. Mar 1989;34(3):322-3. [Medline].

  16. American College of Physicians. Clinical Competence in Percutaneous Liver Biopsy. In: American College of Physicians Guidelines.

  17. Reddy KR, Schiff ER. Complications of Liver Biopsy. In: Taylor MB. Gastrointestinal Emergencies. 2nd. Baltimore, MD: Williams & Wilkins; 1996.

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Further Reading

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Keywords

percutaneous liver biopsy, liver biopsy, liver tissue sampling, hepatic biopsy, liver disease, hepatic disease, hepatic failure, liver failure, liver disease diagnosis, liver disease workup, liver disease work-up, percutaneous suction needle liver biopsy, tru-cut liver biopsy, menghini needle biopsy, modified menghini needle biopsy, jamshidi needle biopsy, liver evaluation

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Contributor Information and Disclosures

Author

Gaurav Arora, MD, MS, Fellow in Gastroenterology and Hepatology, University of Texas Medical School at Houston and MD Anderson Cancer Center; Former Advanced Hepatology Fellow, Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine
Gaurav Arora, MD, MS is a member of the following medical societies: American Association for the Study of Liver Diseases, American Association of Physicians of Indian Origin, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society of Gastrointestinal Endoscopy, Medical Council of India, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Coauthor(s)

Walid S Ayoub, MD, Clinical Assistant Professor of Medicine, Division of Gastroenterology and Hepatology and Liver Transplant Program, Stanford University School of Medicine
Disclosure: Nothing to disclose.

Emmet B Keeffe, MD, MACP, Professor of Medicine Emeritus, Stanford University Medical Center
Emmet B Keeffe, MD, MACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Hepato-Pancreato-Biliary Association, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Transplantation, and International Liver Transplantation Society
Disclosure: Bristol-Myers Squibb, Gilead, Novartis, Idenix, Roche, Romark Consulting fee Consulting; Romark Laboratories Salary Employment

Medical Editor

Joseph K Lim, MD, Assistant Professor of Medicine, Director, Yale Viral Hepatitis Program, Section of Digestive Diseases, Yale University School of Medicine
Joseph K Lim, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

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