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What is a liver biopsy?

A liver biopsy is a procedure to remove a small piece of the liver so it can be examined with a microscope for signs of damage or disease. Interventional radiologists perform a liver biopsy with “image guidance,” meaning that the biopsy needle is placed using either ultrasound, X-ray, or CT imaging during the procedure to safely pass the needle into the appropriate area in the liver.

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Why do I need to do this procedure?

There are two main reasons to do the procedure:

  1. Abnormal liver function: Patients that have abnormal liver function may need a liver biopsy to identify the cause of the dysfunction and the degree of damage. Usually, the liver dysfunction is identified by abnormal laboratory tests ( AST, ALT, Alkaline phosphatase, bilirubin… )

  2. Liver lesion: If you have a liver lesion found by CT scan, ultrasound or MRI, often a biopsy is necessary to identify the cause of the liver lesion.

How is the procedure done?

The procedure is done at El Camino Hospital where you will be set up with an IV to allow access for moderate (also known as “twilight”) sedation. You will then be taken to the procedure room where you will have a team consisting of a nurse, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation).

Percutaneous liver biopsy (CT or ultrasound guided)

  • You will lie on your back, with your right hand over your head.

  • A scout scan with CT or ultrasound will be done to localize the liver and possible liver lesion(s).

  • A medication to numb the procedure site (local anesthetic) will be administered.

  • A biopsy needle will be inserted and several samples of tissue will be taken.

  • You may be asked to hold your breath as each sample is taken.

  • The procedure site will be closed with sterile skin glue.

  • A post-biopsy scan will be done to check for any bleeding.

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Transjugular liver biopsy (X-ray guided)

  • You will lie on your back on an X-ray table, with your head turned to your left.

  • An limited ultrasound of the right neck just over your jugular vein will be done.

  • A medication to numb the area (local anesthetic) will be administered.

  • A tiny catheter will be inserted into the jugular vein all the way down to a blood vessel in the liver called the hepatic vein.

  • Contrast dye may be injected through the catheter to visualize the hepatic vessels better.

  • X-rays will be taken and the dye will make the blood vessels in the liver light up on the X-rays.

  • The biopsy needle will be placed through the tube until it reaches the liver.

  • Samples of liver tissue will be taken with the biopsy needle.

  • The needle and the tube will be removed.

  • The puncture site will then be sealed with sterile skin glue.

What are the possible complications of a liver biopsy ? 

  1. Bleeding: Although bleeding is rare (~1% ), it is the main complication. It is usually internal bleeding and it is usually manifested by worsening or changing pain, right upper abdominal pain or right shoulder pain, lightheadedness, dizziness, or low blood pressure.

  2. Non-diagnostic biopsy: Although also rare, sometimes the tissue collected may not be enough to make the diagnosis. In that case you should talk with your Interventional Radiologist, to decide whether a repeat biopsy or a surgical biopsy is needed.

Care at the procedure site:

The puncture site is tiny and so there is little care that you will need to do.  Sometimes we use a dab of skin glue at the puncture site, and the glue will wear off by itself in 1-2 weeks. You do not need to do anything. 

When will the results of the biopsy be ready ?

The results of the biopsy are usually ready in 2 business days. They will be forwarded to your physician who referred you to us. However, although some preliminary results are available in this time frame, in more difficult cases, additional tests may be necessary and may take several more days. Sometimes, we automatically send the samples for a second opinion at a separate institution ( ie, Stanford, UCSF, Harvard or Mayo Clinic), which can also take additional time. 

​Can I get copies of the pathology reports and medical records ? 

Absolutely. All the medical records are yours! You have the right to get a copy of all medical records including the radiographic images and the pathology reports. To obtain the records and the pathology reports, contact El Camino Hospital Medical Records Department at 650-940-7000.Absolutely. All the medical records are yours! You have the right to get a copy of all medical records including the radiographic images and the pathology reports. To obtain the records and the pathology reports, contact El Camino Hospital Medical Records Department at 650-940-7000.

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For radiographic images on a CD you should contact the Radiology Department at 650-940-7050.

Can we send the pathology samples to a second opinion at a separate institution ? 

Absolutely. In certain difficult cases the pathologists can consult with experts at the best institutions. However, most of the time this is not necessary. The El Camino Hospital Pathology team is extremely experienced.  If you would like a second opinion regarding interpretation of the results from your biopsy, contact the department of pathology at El Camino Hospital through the main number, 650-940-7000.

When should you call your physician ?

  • Signs of infection at the procedure site ( redness, tenderness, swelling  and/or pain ).

  • New onset or worsening of abdominal or right shoulder pain following the biopsy.

  • Severe lightheadedness and  dizziness

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You can reach your Interventional radiologist at 650-404-8445

General Instructions:

Sedation

  • If you receive sedation during the procedure, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Activity

  • You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.

  • No exercising, lifting heavy objects or strenuous activity for the next 7 days.

Pain Management

  • Some pain or discomfort at the site of the procedure may be normal. However, it should not be getting worse.

  • It is also normal to have discomfort in the right shoulder area after the procedure, due to referred pain.

  • Unless you have been told to avoid certain medications, you may use over the counter medication such as Acetaminophen/Tylenol for minor discomfort, unless you are restricted from taking these medications.

  • Usually, the pain is not severe and does not require stronger medications. If your pain is very severe it could indicate a bleeding complication.

  • If you feel that Tylenol is not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.

Diet

  • ​You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

Shower

  • You can take a shower tonight. You should not soak the wound in water (ie. bath and swimming pool) for 1 week. 

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