Liver biopsy

A liver biopsy gives histological and other information that can not be obtained by other methods. Although only a small piece of tissue is examined with biopsy, this sample is usually representative, even with focal lesions. Biopsy under the supervision of ultrasound or CT is more effective. For example, with metastases, the sensitivity of a biopsy performed under ultrasound control is 66%. The biopsy is especially valuable for the diagnosis of tuberculosis or other granulomatous infiltrate, as well as in assessing the condition and viability of the transplant (ischemia, rejection, biliary tract disease, viral hepatitis) after liver transplantation. A series of biopsies performed usually for several years may be necessary to control the progression of the disease.

Macroscopic and histopathological studies are most often final. In some cases, cytological analysis, the study of frozen sections and sowing may be required. In a biopsy, the content of copper metals can be determined if there is a suspicion of Wilson's disease and iron in hemochromatosis.

[1], [2], [3], [4], [5]

Indications for liver biopsy

• Changes in parameters of hepatic enzymes of unknown origin
• Alcoholic liver disease or non-alcoholic steatosis (diagnosis and stage identification)
• Chronic hepatitis (diagnosis and stage identification)
• Suspicion of rejection after liver transplantation, which can not be diagnosed by less invasive methods
• Hepatosplenomegaly of unknown etiology
• Inexplicable intrahepatic cholestasis
• Suspicion of malignancy (focal lesions)
• Changes in parameters of hepatic enzymes of unknown origin
• Unexplained systemic manifestations of the disease, for example fever of unknown etiology, inflammatory or granulomatous diseases (sowing of material obtained from biopsy)

The effectiveness of diagnostic biopsy is limited by the following factors:

1. error when taking a sample;
2. random errors or doubts in cases of cholestasis and
3. need for a qualified pathomorphologist (many pathologists do not have experience with samples taken with fine needle biopsy).

A liver biopsy can be performed transdermally at the patient's bedside or under ultrasound control. The latter option is preferable, as with this, there are fewer complications, and it is also possible to visualize the liver and purposefully focal lesions.

Contraindications to liver biopsy

Absolute contraindications are the inability to provide patient immobility and breath retention during the procedure, as well as the risk of bleeding (MHO> 1.2, despite obtaining vitamin K, bleeding time> 10 min) and severe thrombocytopenia (<50 000 / ml). Relative contraindications include severe anemia, peritonitis, severe ascites, high levels of biliary obstruction and sub-diaphragmatic or right-sided infected pleurisy or effusion. Nevertheless, percutaneous liver biopsy is quite safe when performed on an outpatient basis. Mortality is 0.01%. Major complications (for example, intra-abdominal bleeding, bile peritonitis, rupture of the liver) develop in approximately 2% of cases. Complications usually become evident within 3-4 hours; this is the period recommended for monitoring the patient.

Transgular catheterization of hepatic veins with biopsy is used in patients with severe coagulopathy. The procedure involves cannulation of the right internal jugular vein and conducting a catheter through the inferior vena cava into the hepatic vein. A thin needle moves through the hepatic vein into the liver tissue. Successful biopsy is achieved in more than 95% of cases, with a small number of complications - in 0.2% of cases bleeding occurs from the puncture site of the liver capsule.

[6], [7]