Percutaneous Liver Biopsy ?>

Percutaneous Liver Biopsy

Percutaneous Liver Biopsy
Introduction

Percutaneous liver biopsy is a procedure in which a long needle is introduced through the skin, subcutaneous tissues, intercostal muscles, and peritoneum into the liver to obtain a specimen of liver tissue.1, 2 This procedure is usually performed on an outpatient basis. The patient is then observed for a few hours in the hospital or the ambulatory unit.

The liver biopsy needle used can be one of the following 3 types:
Cutting needle
Suction needle (discussed in this article)
Spring-loaded needle
This topic focuses on the technical aspects of performing a percutaneous liver biopsy. For a more detailed discussion of the theoretical aspects, please see Diagnostic Liver Biopsy.

Indications

Initial diagnosis 3

Evaluation of abnormal liver test results, if all other workup is unrevealing
Determination of stage of fibrosis and grade of inflammation for chronic hepatitis B and hepatitis C 4
Evaluation of autoimmune hepatitis
Evaluation of a liver mass that does not exhibit typical imaging features of hepatocellular carcinoma (HCC)
Quantitative estimation of iron in hemochromatosis
Quantitative estimation of copper in Wilson disease
Estimation of the severity of alcoholic liver disease
Evaluation of drug toxicity
Evaluation of the suitability of a donor liver for transplantation
Diagnosis and staging of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH)
Evaluation of unexplained jaundice
Diagnosis of cholestatic liver disease
Evaluation of infiltrative or granulomatous disorders
Evaluation of liver injury from immunosuppressive agents (methotrexate)
Surveillance during treatment
Follow-up evaluation while on antiviral treatment for chronic hepatitis C (rare)
Monitoring of disease activity of autoimmune hepatitis during treatment (may assist in determining if therapy can be discontinued)
Posttransplant (liver)
Diagnosis of acute cellular rejection
Diagnosis of chronic rejection
Diagnosis of recurrent hepatitis C
Diagnosis of posttransplant lymphoproliferative disorder
Diagnosis of cytomegalovirus (CMV) hepatitis
Protocol biopsies to monitor for fibrosis or inflammation (particularly in patients who received liver transplants to treat liver failure in chronic hepatitis C)
Contraindications
Uncooperative patient5
Inability to identify a suitable biopsy site by either percussion or ultrasonographic guidance
Prolonged (>1.5) international normalized ratio (INR)6
Decreased platelet count (<60,000/mm3)
Bleeding diathesis (eg, hemophilia)
Recent use (within the last 7 days) of aspirin or nonsteroidal anti-inflammatory drugs (NSAID) or antiplatelet class of medications
Unavailability of blood products for transfusion
Morbid obesity of patient
Ascites
No backup support available from surgery or interventional radiology in case of a complication
Suspected hemangioma or hepatic echinococcal cysts
Abdominal wall infection over the identified biopsy site
Infection in the right pleural cavity or below the right hemidiaphragm
Bowel overlying biopsy site (on ultrasound or other abdominal imaging)

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