What is the liver biopsy procedure and how is it done?

Liver biopsies; is performed for two purposes: biopsies taken from the organ itself, which we call the parenchyma of the liver, and from masses that are suspicious of tumors that belong to the liver itself or spread to the liver from other organs.

Liver parenchymal biopsies are performed to reveal the severity and cause of the involvement in pathologies that affect the entire liver, which we call hepatitis. A parenchymal biopsy is often requested by the relevant clinical branch in cases of changes in some blood tests with signs of deterioration in liver function tests and in patients with jaundice. It is usually done under ultrasound guidance.

The liver is one of the most common places where cancers in other parts of the body spread, and when there is a mass in the liver in cases with cancer in other organs, or in cancer types that originate from the liver, such as biliary tract cancer, liver mass biopsy is required to detect the origin of the mass and to distinguish between good and bad. It is done under the guidance of ultrasound or computed tomography (CT).

Before the liver biopsy is performed, bleeding and coagulation parameters such as hemogram, INR, APTT, and blood values are checked. Medicines called blood thinners are stopped on average 5 days before the procedure, since the procedure is done as we call core biopsy (cutting biopsy) or trucut biopsy, and fine-needle aspiration biopsy is not preferred much (due to diagnostic limitations). Vascular access is opened. Blood values are checked. The procedure is mostly performed under ultrasound guidance, and CT guidance is used to take a biopsy from masses that are difficult to locate and cannot be seen clearly on ultrasound. The procedure is usually done with a technique called the coaxial (double-needle system) technique. With ultrasound or CT, the place to enter the mass and the safe route of the needle are determined. After cleaning the skin, a local anesthetic is injected into the area where the needle will pass, from under the skin to the outer part of the liver capsule. Pain relievers or sedative medications can be given through the existing vascular access. After the point of entry is determined, the needle that allows a thinner needle to pass through what we call the coaxial needle is advanced by ultrasound to the area where the vascular structures are the least in a parenchymal biopsy. Afterward, the fine needle in the coaxial needle is removed and the appropriate automatic biopsy needle is inserted, and a piece is obtained from different parts 2-3 times with this needle. When a biopsy is to be taken from the mass, it is entered into the mass by avoiding the vessels under the guidance of ultrasound or CT. After it is seen that we are in the mass, the fine needle in the coaxial needle is removed and the appropriate automatic biopsy needle is inserted, and a piece of the mass is obtained from different parts 3-4 times with this needle. The obtained materials are evaluated by the pathologist during the process and if sufficient material is obtained, the process is terminated. In centers where onside pathology specialists are not available, the material is prepared appropriately and sent to the pathology laboratory. Afterward, first, the automatic biopsy needle and then the coaxial needle are withdrawn, and the control ultrasound or CT is taken and bleeding, etc. check if there is. The skin is cleaned in a sterile way and covered with small gauze we call a sponge. The patient is kept under observation for about 4 hours and then discharged after clinical and, if necessary, blood test or ultrasound control.

The most important risk of liver biopsy is bleeding. The risk of bleeding requiring blood transfusion or medical intervention is very low in the appropriate technique and experienced hands.