Liver Biopsy

1. How can a liver biopsy help?

Lver biopsies may be useful in two ways. Firstly biopsy may be essential to diagnose the cause of the liver disease when blood tests are unhelpful. If there is any doubt about the cause of a liver problem then a biopsy may help make the diagnosis. Secondly, a biopsy is a good techniques for assessing the extent or severity of damage to the liver, however, it is only a tiny sample and is not always truely representative of the whole liver. Thus in individuals with hepatitis C infection it provides reliable information about the degree of liver damage and is valuable in planning future management. Although the blood 'liver function tests' provide a measure of the inflammation in the liver they do not reflect how severely it is affected by a disease process. At present there are no good blood tests which reveal the extent to which the liver is damaged by cirrhosis or scarring. If your doctor is confident that you have cirrhosis it is not usually helpful to have a biopsy as it will not provide any further useful information in helping to decide whether to recommend interferon.

2. Should a liver biopsy be performed prior to treatment for hepatitis C?

In people without haemophilia a liver biopsy is considered advisable by many doctors before prescribing interferon. This will provide good information about the severity of liver disease; this may influence the decision about interferon therapy. If there is only very mild liver disease or cirrhosis is present some physicians might not recommend interferon. In those with haemophilia, however, it is not usually essential prior to interferon therapy. Many doctors will offer interferon to those with haemophilia without a biopsy.

3. How is a liver biopsy performed?

The procedure for obtaining biopsy of the liver is a well established technique that has been used for many years. Most biopsies are performed by first anaesthetising a small area of skin over the liver in the upper part of the abdomen and then passing a special biopsy needle through the skin into the liver. On withdrawing the needle a small piece of liver about 1-2mm in diameter and perhaps 10mm long is retained with it. This is sent to the pathology department where it is processed and examined under the microscope. Following the procedure some individuals have a mild discomfort at the site of the biopsy for a day or so.

4. Is a liver biopsy safe?

Liver biopsies 10 to 20 years ago were associated with more side effects. Biopsies today are performed using safer needles and may be undertaken with the help of ultrasound which can visualise the liver on a television screen thus ensuring that the doctor can guide the needle into the liver. Some centers use a laparoscope which is a tiny telescope which can be inserted through a small incision in the abdominal wall and can be used to visualise the liver to ensure that the biopsy needle enters it safely. Using a laparoscope it is also possible to see the degree of inflammation and scarring on the liver surface. There is a small risk of bleeding after a biopsy. Very occasionally the bleeding will be problematic and an operation will be required.

5. Should I have a biopsy?

If your doctor suggests that you have a liver biopsy you should ensure that you receive a full explanation as to why it is considered necessary and exactly how it will be performed. With this information you should be able to make a decision that is reasonable for your circumstances.