Liver biopsy

Liver biopsy is the biopsy (removal of a small sample of tissue) from the liver. It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment.cite journal |author=Grant A, Neuberger J |title=Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology |journal=Gut |volume=45 Suppl 4 |issue= |pages=IV1–IV11 |year=1999 |month=October |pmid=10485854 |pmc=1766696 |doi= |url=http://gut.bmj.com/cgi/content/full/45/suppl_4/IV1]

Types

Liver biopsies may be taken percutaneously (via a needle through the skin), transvenously (through the blood vessels) or directly during abdominal surgery. The sample is examined by microscope, and may be processed further by immunohistochemistry, determination of iron and copper content, and microbiological culture if tuberculosis is suspected.

Indications

Liver biopsy is often required for the diagnosis of a liver problem (jaundice, abnormal blood tests) where blood tests, such as hepatitis A serology, have not been able to identify a cause. It is also required if hepatitis is possibly the result of medication, but the exact nature of the reaction is unclear. Alcoholic liver disease and tuberculosis of the liver may be diagnosed through biopsy. Direct biopsy of tumors of the liver may aid the diagnosis, although this may be avoided if the source is clear (e.g. spread from previously known colorectal cancer).

If the diagnosis is already clear, such as chronic hepatitis B or hepatitis C, liver biopsy is useful to assess the severity of the associated liver damage. The same is true for haemochromatosis (iron overload), although it is frequently omitted. Primary biliary cirrhosis and primary sclerosing cholangitis may require biopsy, although other diagnostic modalities have made this less necessary.

Occasionally, liver biopsy is required to monitor the progress of treatment, such as in chronic viral hepatitis. Liver biopsies can also be done during weight loss surgery, to look for non-alcoholic fatty liver disease.

Contraindications

While liver biopsy is generally a safe procedure, there is a small risk of complications, especially bleeding. Several precautions need to be taken, and particular situations (such as high bleeding risk) can partially or completely prohibit liver biopsy. Care must be taken not to puncture other organs such as the lung (above the liver), the diaphragm, or the intestines.

History

The first liver aspirate was performed by the German physician Paul Ehrlich in 1883. Percutaneous liver biopsy was first reported in the 1920s. The transjugular approach was pioneered by radiologist Charles Dotter in the 1970s. [cite journal |author=Rösch J, Lakin PC, Antonovic R, Dotter CT |title=Transjugular approach to liver biopsy and transhepatic cholangiography |journal=N. Engl. J. Med. |volume=289 |issue=5 |pages=227–31 |year=1973 |month=August |pmid=4713761]

References