Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy
- Arturo Bravo, MD
Arturo Bravo, MD
- Assistant Clinical Professor of Medicine
- University of Texas Health Science Center at San Antonio
- Sunil G Sheth, MD
Sunil G Sheth, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
The first percutaneous liver biopsy was performed in 1883 in Germany . 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 .
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  (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 .
There are several methods for procuring liver tissue: percutaneous, transjugular, laparoscopic, or ultrasound or computed tomography-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.
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- AASLD GUIDELINES
- PREPARATION OF THE PATIENT
- Evaluation of coagulation status
- Informed consent
- Dietary recommendations
- Conscious sedation
- Special settings
- - Chronic renal failure
- - Oral anticoagulants
- - Hemophilia
- - AIDS
- - Amyloid
- - Sickle cell hepatopathy
- Role of radiologic guidance
- Post-biopsy care
- Bile peritonitis
- Transient bacteremia
- FINE-NEEDLE ASPIRATION BIOPSY
- LAPAROSCOPIC LIVER BIOPSY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS