Liver Biopsy (cont.)
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Risks of Liver Biopsy
Pain or discomfort at the biopsy site is experienced by almost all patients who undergo biopsy. Local anesthesia at the biopsy site or mild sedation at the time of biopsy can help to decrease pain. Post-biopsy pain is typically mild to moderate. It may last from hours to days. Some patients make need a low dose of acetaminophen or even a low-dose of a narcotic pain medicine to diminish post-biopsy pain.
It is common that a small hematoma (i.e. "black and blue mark") is seen at the biopsy site. An enlarging hematoma is a worrisome sign that requires the patient to return to the hospital for assessment.
Biopsies of all human tissues are invariably accompanied by some risk of bleeding as a complication. When a biopsy needle enters the liver, it is anticipated that a few drops of blood will leak out of the liver into the abdominal cavity. This should cause no symptoms or problems. Much less commonly, a large amount of blood leaks out of the liver capsule into the abdominal cavity. This may be accompanied by symptoms of severe abdominal or chest pain. Large amounts of bleeding may cause the patient's heart rate to rise or blood pressure to drop. Unexpected significant bleeding may occur after procedures that – from a technical perspective – were performed perfectly. Fortunately, important bleeding only occurs in a small number of patients, somewhere between 1 in 100 and 1 in 1000.
All patients who undergo liver biopsy are monitored after the procedure to make sure they are not experiencing bleeding. If bleeding is suspected, the patient may require overnight observation to make sure that bleeding does not continue. A small minority of patients require blood transfusion to make up for biopsy-associated blood losses. An even smaller number of patients require emergent procedures (for example, surgery) to stop continuing bleeding.
Infrequent complications of liver biopsy include: striking another organ (for example, puncturing the lung, intestine, gallbladder or bile duct) or causing infection. Transjugular liver biopsies can be complicated - infrequently - by injury to the blood vessel or heart arrhythmias.
Ultrasound and CT-guided biopsy of liver masses have their own associated risks. First, there is the issue of "tumor tracking." Biopsy of a malignant (i.e. cancerous) liver mass is associated with a <1% chance of tumor seeding (i.e. depositing a viable cancer cell in the tract created by the liver biopsy needle that subsequently grows into a mass of tumor cells). Also, there is up to a 30% miss-rate associated with biopsy of the malignant mass. Thus, the biopsy of the malignant mass has up to a 30% chance of providing incorrect information, misleading the physician and the patient to believe that a malignant mass might be benign. Therefore, if a strong suspicion for malignancy remains after receiving a "benign" diagnosis, the liver biopsy should be repeated.
David C. Wolf, M.D., FACP, FACG, AGAF
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