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Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy

INTRODUCTION

The first percutaneous liver biopsy was performed in 1883 in Germany [1]. However, the technique required up to a 15-minute intrahepatic phase, making it impractical and probably unsafe. The procedure became more widely used after Menghini reported a quick "one-second needle biopsy of the liver" technique in 1958 [2].

The histopathologic examination of biopsy tissue can provide otherwise unobtainable qualitative information regarding the structural integrity of the liver and the type and degree of injury and/or fibrosis [3]. (See "Histologic scoring systems for chronic liver disease".) It is also useful for monitoring the efficacy of treatment and permits the definitive diagnosis of tumors.

A liver biopsy is usually performed only after a thorough noninvasive clinical evaluation in patients with chronically (greater than six months) elevated liver biochemical tests. (See "Approach to the patient with abnormal liver biochemical and function tests".) The pertinent clinical information should be made available to the pathologist so that the histopathological findings can be interpreted in the appropriate clinical context [4].

There are several methods for procuring liver tissue: percutaneous, transjugular, laparoscopic, or ultrasound or CT-guided fine-needle aspiration (FNA). Each has inherent advantages and disadvantages. The decision to select a particular technique is based upon available expertise and the particular clinical situation.

  • The conventional, percutaneous liver biopsy is the simplest, quickest, and most commonly performed approach in modern medical practice, and is very safe in experienced hands.
  • FNA provides a small number of cells for cytological examination; thus, it is not a true tissue biopsy. It is often used when a specific lesion needs to be sampled.
  • Laparoscopic liver biopsy is likely to have a higher diagnostic yield in patients with cirrhosis compared to percutaneous liver biopsy and is excellent for staging the extent of disease in patients with various intraabdominal malignancies. However, it requires general anesthesia, which is associated with increased risk and cost.
  • The transjugular technique is more invasive than the percutaneous approach, but is useful in patients with a bleeding diathesis or in whom the percutaneous technique is otherwise contraindicated.

                             

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Literature review current through: Apr 2013. | This topic last updated: May 11, 2012.
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