Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
For almost a century, physicians have employed liver biopsy to help diagnose
the cause and assess the severity of their patients' liver disease. Liver
biopsy entails the removal a small piece of tissue from the liver. That
piece of tissue is then sent to the pathology laboratory for analysis.
Reasons for Liver Biopsy
Physicians typically employ a broad array of blood tests and imaging studies
(for example, CT,
MRI scans) in an effort to diagnose a patient's liver disease.
In some circumstances, those tests do not lead to a diagnosis. A liver
biopsy is a key tool in helping the physician make a correct diagnosis of a
patient's underlying liver disease.
In some circumstances, a patient's clinical history, blood tests, or imaging
studies may strongly suggest a particular diagnosis. Liver biopsy is used
to confirm the physician's clinical suspicions. This is particularly important
in view of the fact that many liver diseases require life-long therapy.
Making a correct diagnosis is critical before committing the patient to a long
course of treatment with a particular drug.
In other circumstances, blood test results may point to the co-existence of
two liver diseases in the same patient at the same time (for example, alcoholic
hepatitis as well as
chronic hepatitis C). Thus, liver biopsy results may
clarify whether a patient is suffering from one or two diseases.
Liver biopsy results may be used to monitor the effectiveness of therapy. As
an example, a patient under long-term medical therapy for autoimmune hepatitis
may require a follow-up liver biopsy to determine whether or not therapy is
successful at suppressing the hepatitis.
Liver biopsy also can be used to assess the severity of a patient's
condition. As an example, a patient's clinical history and laboratory
tests might strongly point to a diagnosis of chronic hepatitis C (CHC).
Knowledge of the severity of the patient's chronic hepatitis C will help determine whether the
patient needs immediate therapy or whether therapy can be deferred to a later
date.
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A liver biopsy is done using a needle inserted between two of the right lower ribs to remove a sample of liver tissue. The tissue sample is sent to a laboratory and looked at under a microscope to see if there are any liver problems.
Samples of liver tissue sent to a pathology lab will be looked at under a microscope for liver diseases such as liver cancer or cirrhosis.
Other samples of liver tissue may be sent to a microbiology lab to see whether an infection, such as tuberculosis of the liver, is present.
Test results are generally ready in 2 to 4 days. If tests are done to find infections, it may take several weeks for the results to be ready.
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.
