This is the procedure where a needle is inserted through the abdominal wall into the liver to remove a tiny sample of the liver tissue. After the liver tissue is removed by the needle it is sent to a pathology laboratory where it is examined by a specialist pathologist under a high powered microscope. The pathologist is able to see if the liver cells are healthy, if there is a lot of fat in the liver and if there is a lot of scar tissue destroying the liver architecture.
A liver biopsy procedure and post-operative observation period takes on average 18 hours. You do not need a general anesthetic. A liver biopsy is not considered to be a major procedure although there is a small chance of serious post-procedure complications such as infection or internal bleeding (hemorrhage). The death rate from such complications is 1 in 10,000 patients undergoing a liver biopsy.
Liver biopsy is considered to be an accurate way to determine if your liver tissue looks healthy, fatty or inflamed, or if you have cirrhosis. However it has drawbacks, as the doctor is only able to sample a tiny piece of liver tissue, which may not be representative of the condition of the entire liver – thus the accuracy of liver biopsy is affected by the sampling tissue and it’s possible to miss areas of disease and thus assume the liver is healthier than it is.
Conversely you may sample an area that is badly inflamed and yet the rest of the liver is much healthier than that sample. Therefore treatment decisions may not be correct and may be over zealous. For those who are interested in pathology, the types of Non-Alcoholic Fatty Liver Disease (NAFLD) have been categorized by the appearance of the liver tissue under the microscope as follows:
Type 1 = fatty infiltration alone Type 2 = fatty infiltration plus inflammation of liver cells Type 3 = fatty infiltration, inflammation plus severe swelling of liver cells by fat (ballooning) Type 4 = all the above changes plus scarring and fibrosis (cirrhosis)
In the USA a safer alternative test to liver biopsy is becoming more available – this has been developed by the Mayo Clinic and is called an MRE screening test – www.mayoclinic.org/magnetic-resonance-elastography/
Case Study: Liver Biopsy
I recently saw a 65 year old man who had a very unfortunate experience after having a liver biopsy. He had consulted a liver specialist because he had raised liver enzymes in a blood test for liver function. He had the liver biopsy done in a private hospital under radio-imaging and it was noticed that he was bleeding from the liver in the area of the biopsy, so he was admitted to this private hospital overnight for observation.
Well, by the next morning he had lost so much blood he went into hypo-volemic shock (extremely low blood pressure causing lack of blood flow to vital organs). This shock caused his kidneys to fail and he was admitted to another hospital in the intensive care ward where he had dialysis.
Whilst he was recovering and became well enough to walk, he had a fall in the hospital and fell heavily onto his right ear. This caused damage to the 5th and 7th cranial nerves (trigeminal and facial nerves). He has permanent nerve damage and nerve pain from this accident and has to take strong pain killers.
This patient now has permanent kidney failure and was doing peritoneal dialysis at home and developed infections in the abdominal cavity. He has been extremely fatigued and had to sell his successful business and is unable to work. His kidneys will never recover. His liver problem is now the least of his worries. Before his liver biopsy his kidney function was completely normal.
By the way, his liver biopsy showed amyloidosis of the liver. This is a condition where abnormal proteins infiltrate the liver. Conventional medical treatments do not generally work well and are not curative.
Many patients have a liver biopsy with no complications, but when a liver biopsy goes wrong, it can be extremely serious.
When considering a liver biopsy, it is wise to get a second opinion.
Ask the doctor the following –
- Will the results of my biopsy enable me to find a cure for my problem?
- Are there other techniques that are not invasive and are free of risk to diagnose the cause of my liver problem?
- Can I have a Fibroscan ultrasound test to check for cirrhosis instead of putting myself through a liver biopsy?
- Are blood tests accurate enough to diagnose the cause of my liver problem?
- Can I wait a while and try nutritional medicine to see if my liver function tests improve?
Sometimes I say to my patients “Should I have this test or go bungy jumping instead?”
A liver biopsy is an inherently risky diagnostic procedure, and in recent years is not performed as frequently. Apart from risks such as bleeding and infection, a biopsy can have a high rate of false negative results. That means the particular liver cells analysed in the biopsy look normal, however surrounding liver tissue is diseased. Therefore many doctors are giving their patients a Fibroscan instead, because it is much safer and can give a very accurate result.
A Fibroscan uses an ultrasound to create waves and measures the speed at which these waves are reflected by the liver. The speed of the wave determines the degree of liver stiffness. The more scarred the liver, the stiffer it becomes and the stiffer the liver the quicker the waves are reflected.
Fibroscan was invented to assess the amount of scarring (fibrosis) present in the liver which develops in cirrhosis. It does this by measuring the stiffness or elasticity of the liver. Results are presented as a number in kilopascals (kPa). The higher the number, the stiffer and thus more scarred the liver.
Please remember, whenever considering any invasive tests or procedures or surgery, get a second opinion and take your time to do your research. For information about a range of liver conditions, including cirrhosis and hepatitis, see my book The Liver Cleansing Diet.