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: Oct 2014. | This topic last updated: Jan 10, 2014.
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References
Top
  1. van Leeuwen DJ, Wilson L, Crowe DR. Liver biopsy in the mid-1990s: questions and answers. Semin Liver Dis 1995; 15:340.
  2. MENGHINI G. One-second needle biopsy of the liver. Gastroenterology 1958; 35:190.
  3. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344:495.
  4. Czaja AJ, Carpenter HA. Optimizing diagnosis from the medical liver biopsy. Clin Gastroenterol Hepatol 2007; 5:898.
  5. Rockey DC, Caldwell SH, Goodman ZD, et al. Liver biopsy. Hepatology 2009; 49:1017.
  6. Eastwood GL. Liver Biopsy. In: Atlas of Bedside Procedures, 2nd ed, VanderSalm TJ, Cutler BS, Wheeler HB (Eds), Little Brown, Boston 1988. p.393.
  7. Patel IJ, Davidson JC, Nikolic B, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23:727.
  8. Garcia-Tsao G, Boyer JL. Outpatient liver biopsy: how safe is it? Ann Intern Med 1993; 118:150.
  9. Boberg KM, Brosstad F, Egeland T, et al. Is a prolonged bleeding time associated with an increased risk of hemorrhage after liver biopsy? Thromb Haemost 1999; 81:378.
  10. Blake JC, Sprengers D, Grech P, et al. Bleeding time in patients with hepatic cirrhosis. BMJ 1990; 301:12.
  11. Kowdley KV, Aggarwal AM, Sachs PB. Delayed hemorrhage after percutaneous liver biopsy. Role of therapeutic angiography. J Clin Gastroenterol 1994; 19:50.
  12. Alexander JA, Smith BJ. Midazolam sedation for percutaneous liver biopsy. Dig Dis Sci 1993; 38:2209.
  13. Reddy KR, Schiff ER. Complications of liver biopsy. In: Gastrointestinal emergencies, 2nd ed, Taylor, Gollan, Steer, Wole (Eds), Williams & Wilkins, Baltimore 1997. p.959.
  14. Pawa S, Ehrinpreis M, Mutchnick M, et al. Percutaneous liver biopsy is safe in chronic hepatitis C patients with end-stage renal disease. Clin Gastroenterol Hepatol 2007; 5:1316.
  15. Aledort LM, Levine PH, Hilgartner M, et al. A study of liver biopsies and liver disease among hemophiliacs. Blood 1985; 66:367.
  16. Gordon SC, Veneri RJ, McFadden RF, et al. Major hemorrhage after percutaneous liver biopsy in patients with AIDS. Gastroenterology 1991; 100:1787.
  17. Ruijter TM, Jan KM, Schattenker E, et al. Diagnostic value of liver biopsy in symptomatic HIV-1-infected patients. Eur J Gastroenterol Hepatol 1993; 5:641.
  18. Park MA, Mueller PS, Kyle RA, et al. Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients. Medicine (Baltimore) 2003; 82:291.
  19. Zakaria N, Knisely A, Portmann B, et al. Acute sickle cell hepatopathy represents a potential contraindication for percutaneous liver biopsy. Blood 2003; 101:101.
  20. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 1990; 99:1396.
  21. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2:165.
  22. Colombo M, Del Ninno E, de Franchis R, et al. Ultrasound-assisted percutaneous liver biopsy: superiority of the Tru-Cut over the Menghini needle for diagnosis of cirrhosis. Gastroenterology 1988; 95:487.
  23. Smith CI, Grau JE. The effects of ultrasonography on the performance of routine liver biopsy. Hepatology 1995; 22:384.
  24. Vautier G, Scott B, Jenkins D. Liver biopsy: blind or guided? BMJ 1994; 309:1455.
  25. Riley TR 3rd. How often does ultrasound marking change the liver biopsy site? Am J Gastroenterol 1999; 94:3320.
  26. Lindor KD, Bru C, Jorgensen RA, et al. The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology 1996; 23:1079.
  27. Caturelli E, Giacobbe A, Facciorusso D, et al. Percutaneous biopsy in diffuse liver disease: increasing diagnostic yield and decreasing complication rate by routine ultrasound assessment of puncture site. Am J Gastroenterol 1996; 91:1318.
  28. Younossi ZM, Teran JC, Ganiats TG, Carey WD. Ultrasound-guided liver biopsy for parenchymal liver disease: an economic analysis. Dig Dis Sci 1998; 43:46.
  29. Pasha T, Gabriel S, Therneau T, et al. Cost-effectiveness of ultrasound-guided liver biopsy. Hepatology 1998; 27:1220.
  30. Firpi RJ, Soldevila-Pico C, Abdelmalek MF, et al. Short recovery time after percutaneous liver biopsy: should we change our current practices? Clin Gastroenterol Hepatol 2005; 3:926.
  31. Beddy P, Lyburn IL, Geoghegan T, et al. Outpatient liver biopsy: a prospective evaluation of 500 cases. Gut 2007; 56:307.
  32. Jacobs WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Dig Dis Sci 1989; 34:322.
  33. Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8:877.
  34. West J, Card TR. Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology 2010; 139:1230.
  35. Froehlich F, Lamy O, Fried M, Gonvers JJ. Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci 1993; 38:1480.
  36. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993; 118:96.
  37. Van Thiel DH, Gavaler JS, Wright H, Tzakis A. Liver biopsy. Its safety and complications as seen at a liver transplant center. Transplantation 1993; 55:1087.
  38. Castéra L, Nègre I, Samii K, Buffet C. Pain experienced during percutaneous liver biopsy. Hepatology 1999; 30:1529.
  39. Hederström E, Forsberg L, Florén CH, Prytz H. Liver biopsy complications monitored by ultrasound. J Hepatol 1989; 8:94.
  40. Raines DR, Van Heertum RL, Johnson LF. Intrahepatic hematoma: a complication of percutaneous liver biopsy. Gastroenterology 1974; 67:284.
  41. Forssell PL, Bonkowsky HL, Anderson PB, Howell DA. Intrahepatic hematoma after aspiration liver biopsy. A prospective randomized trial using two different needles. Dig Dis Sci 1981; 26:631.
  42. Lichtenstein DR, Kim D, Chopra S. Delayed massive hemobilia following percutaneous liver biopsy: treatment by embolotherapy. Am J Gastroenterol 1992; 87:1833.
  43. TERRY R. Risks of needle biopsy of the liver. Br Med J 1952; 1:1102.
  44. Ruben RA, Chopra S. Bile peritonitis after liver biopsy: nonsurgical management of a patient with an acute abdomen: a case report with review of the literature. Am J Gastroenterol 1987; 82:265.
  45. Kaw YT, Esparza AR. Cytologic diagnosis of cavernous hemangioma of the liver with fine-needle biopsy. Diagn Cytopathol 1991; 7:628.
  46. Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology 1991; 178:253.
  47. Rodgers MS, Collinson R, Desai S, et al. Risk of dissemination with biopsy of colorectal liver metastases. Dis Colon Rectum 2003; 46:454.
  48. Eisenberg PJ, Boland GW, Mueller PR. Introduction. In: Fine Needle Aspiration Biopsy of the Liver A Color Atlas, Pitman MB, Szyfelbein WM (Eds), Butterworth-Heinemann, Boston 1994. p.3.
  49. Lundquist A. Fine-needle aspiration biopsy of the liver. Applications in clinical diagnosis and investigation. Acta Med Scand Suppl 1971; 520:1.
  50. Vargas C, Jeffers LJ, Bernstein D, et al. Diagnostic laparoscopy: a 5-year experience in a hepatology training program. Am J Gastroenterol 1995; 90:1258.