"We have several biopsy techniques to achieve a sample of liver tissue for analysis. Performing a biopsy does not always mean that the patient has cancer".
DR. JOSÉ IGNACIO HERRERO SANTOS SPECIALIST. HEPATOLOGY UNIT
Liver biopsy consists of obtaining a sample of liver tissue for later study under the microscope.
A puncture is made in the liver with a needle that obtains, by aspiration or by cutting, a small fragment of liver.
There are different techniques:
- Blind percutaneous liver biopsy This is the most common technique. After performing an abdominal ultrasound to identify the liver and rule out the existence of intrahepatic lesions that counteract this technique (vascular lesions, etc.), the puncture is performed.
- Liver biopsy under radiological control. In this technique the puncture is performed under continuous radiological control (mainly ultrasound) that guides the needle at the time of puncture. This technique allows the biopsy to be directed and has its main indication when trying to puncture an intrahepatic lesion, when the size of the liver is smaller than usual or when there are intrahepatic areas that should not be punctured (hemangiomas, intrahepatic vesicle, intestinal interposition, etc.).
- Liver biopsy by laparoscopy. Unlike the previous techniques, it allows direct visualization of the liver and direct haemostatic control in case of haemorrhage.
- Liver biopsy by transjugular route. It is possible to access the liver through the jugular vein. After inserting a catheter through this venous access, the right hepatic vein is reached, which can be punctured to obtain a sample of liver tissue. Although the cost effectiveness of this technique is lower, it is considered appropriate when coagulation is disturbed and therefore there is a high risk of bleeding.
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When is liver biopsy indicated?
With the liver biopsy we can:
- Know the degree of injury of a known chronic liver disease. For example, determine the degree of inflammation in a patient with viral hepatitis or alcoholic hepatitis.
- Establish the diagnosis in a patient with chronic biochemical alteration of the liver tests and whose diagnosis has not been achieved through other analytical, radiological and/or endoscopic studies.
- To know the nature of an intrahepatic lesion, not defined with other studies.
- To study a patient with fever of unknown origin.
- To assess the degree of drug-induced liver injury.
- To quantify the hepatic concentration of iron and/or copper.
- To rule out an infiltrative process in the study of a hepatomegaly.
Most frequent indications of this test:
- Liver Cirrhosis
- Viral Hepatitis
- Alcoholic Liver Disease
Do you have any of these diseases?
You may need to have a liver biopsy
How is a liver biopsy performed?
Liver biopsy is usually performed under a 24-hour admission regime. Prior to the percutaneous biopsy, with or without radiological control, the skin is cleaned with an antiseptic iodine solution and a local anesthetic is administered.
When the anesthetic effect has been achieved, and while the patient holds his breath to avoid injury to the liver, the puncture is performed with a needle that obtains, by aspiration or by cutting, a small fragment of the liver.
Before performing a liver biopsy, an analytical control will be performed, which should include a hemogram and a coagulation study to reduce the risk of bleeding. On the day of the test, the patient must remain fasting.
Likewise, if you are being treated with antiaggregants, anticoagulants or anti-inflammatories, you must stop them a few days before the biopsy is performed.
After the liver biopsy is performed, the patient should remain lying down, at rest and leaning on the biopsy area to make local compression during the first 4 or 6 hours, which are the ones with the highest risk of bleeding.
During this time, blood pressure and heart rate should be checked periodically.
After these first hours, the patient should remain in bed until completing 24 hours. Then he can be discharged and lead a normal life.
Liver biopsy, despite being a good technique to perform, may present complications. Minor complications include pain at the biopsy site and vasovagal syncope. They are the most frequent and easily controlled.
Major complications are less frequent and include:
- Bleeding. It is the most frequent serious complication, ranging from 1.7% to 0.062%.
- Puncture of other organs. It is the second most frequent complication. Puncture of the lung, which is manifested by a pneumothorax, occurs with a frequency of between 0.55% and 0.35%. Puncture of other organs such as kidney, colon and, exceptionally, pancreas, adrenal glands and small intestine has also been described. Most of the punctures of these organs are completely asymptomatic.
- Biliary peritonitis. Its frequency is 0.22% and is due to the puncture of an intrahepatic bile duct, the extrahepatic bile duct or the gallbladder.
- Arteriovenous fistulas. These are produced when the puncture reaches branches of the hepatic and venous arteries. They are usually asymptomatic and tend to close over time.
- Infection. Secondary bacteremia is relatively frequent, especially in patients with cholangitis. Sepsis is less common.
- Tumor spread. Very rare, and always secondary to the puncture of tumor processes.
Where do we do it?
IN NAVARRE AND MADRID
The Hepatology Unit
of the Clínica Universidad de Navarra
We are pioneers in the application of gene therapy in the treatment of liver tumors and hereditary metabolic diseases, and we have extensive experience in the diagnosis and treatment of viral hepatitis and in the treatment of liver cancer using radioembolization systems with Ytrium-90 microspheres.
The Clinic is at the forefront in Spain in performing liver transplantation between living people.
Diseases we treat
Why at the Clinica?
- Highly specialized team of professionals with more than 25 years of experience.
- Nursing team specialized in hepatic patients.
- Important research activity on the molecular mechanisms that cause some of these diseases.