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Biopsy is a study that is widely used in medicine. The term itself comes from the Greek words “bio” – living and “opsis” – to study. In other words, a biopsy is a comprehensive study of a small fragment of living tissue, during which various pathologies can be detected.
The liver is often the “target” of a biopsy, as this organ is vulnerable to various inflammatory and viral diseases. In addition, it is in the liver that metastases often appear in oncological diseases of other organs. It is not always possible to recognize a pathology using ultrasound or tomography, and the study of a tissue sample obtained as a result of a biopsy helps to “shed light” on the essence of the disease, determine its etiology and choose the right treatment method.
Some patients, who are not too aware of the essence of a liver biopsy, are intimidated by this procedure. However, one should not be afraid that the extraction of a fragment of liver tissue will adversely affect the health of the organ. The liver recovers very quickly after any manipulation. In addition, during a biopsy, 1/50 of the organ is removed. This is a negligible amount, and therefore the procedure will not have any negative consequences for the patient’s condition.
Indications for the procedure
You cannot “prescribe” a liver biopsy to yourself. The decision on the need for this type of diagnosis is usually made by a council, which, in addition to the attending physician, includes a hepatologist, an oncologist and an infectious disease specialist.
As a rule, the conclusion about the need for a biopsy is made after an ultrasound or tomographic examination is performed, however, the data obtained are not enough to clarify the etiology of the detected disease.
The reason for the appointment of a biopsy may be serious deviations in the biochemical analysis, as well as an increase in the liver, the nature of which cannot be established. This diagnosis is carried out if a malignant tumor is suspected, as well as when oncology of other organs and the possibility of liver metastases are detected. Also indications for a biopsy are hepatitis, congenital anomalies of the liver, cirrhotic phenomena. Finally, a liver biopsy is performed before and after orthotopic liver transplant surgery.
Before making a final decision to conduct a liver biopsy, the patient must pass a clinical blood test, a coagulogram, tests for HIV and syphilis, as well as an analysis to identify blood group and Rh factor. An EKG is also done. All these studies help to identify possible contraindications for biopsy and to choose the most appropriate procedure for each specific case.
Types of liver biopsy
As noted above, there are several types of liver biopsy. For each of them there are separate indications and contraindications.
The following types of biopsies are currently being performed:
- Percutaneous puncture biopsy of the liver.
- Fine-needle aspiration biopsy under ultrasound or CT guidance.
- Transjugular (transvenous) biopsy.
- Laparoscopic biopsy.
- Incisional biopsy.
Percutaneous puncture liver biopsy
This type of biopsy is most often used to diagnose patients with hepatitis. It is considered the least traumatic, and therefore this procedure is usually performed on an outpatient basis, without hospitalizing patients. It only takes a few minutes for the PCB.
The procedure is carried out as follows. The patient is asked to lie on his back so that the body is slightly tilted to the left. The right hand must be placed behind the head. The puncture site is treated with an antiseptic and local anesthesia is performed. After that, a puncture is performed. To prevent other tissues from entering the needle lumen, sterile saline is drawn into the syringe. In order for the needle to pass more easily, the skin is first pierced with a special stylet or a tiny incision is made with a scalpel. While advancing the needle, the doctor gradually delivers physiological saline from it.
In order to take a sample of liver tissue, the doctor asks the patient to hold his breath and retracts the syringe plunger all the way. The sampling itself takes just a few seconds. After that, the needle is removed, and the puncture site is treated with an antiseptic and a bandage is applied to it. Two hours after the procedure, the patient undergoes an ultrasound of the abdominal organs to exclude the presence of fluid in the puncture area.
As a rule, it is FSBP that is performed for hepatitis, cirrhosis, and also in order to find out the causes of liver enlargement. In addition, this procedure is used to monitor the patient’s condition after transplantation.
Contraindications for diagnostics are the presence of a history of unexplained bleeding, low blood clotting, the presence of hemangioma or echinococcal cyst in the liver. The procedure is not recommended for patients with severe obesity, as well as for those who have been diagnosed with hemophilia.
It should also be mentioned about the possible complications that the procedure can provoke. While PSBP is considered a relatively safe procedure, provided the clinician is experienced and qualified, adverse effects cannot be completely ruled out. So, in 0,2% of cases, bleeding occurs, which is provoked by perforation of the portal vein branches.
Approximately one third of patients complain of pain after the procedure. Pain sensations occur in the right upper square of the abdomen, can be given to the epigastrium and to the right shoulder. As a rule, the pain disappears after the appointment of analgesics within one to two weeks.
The most serious complication is considered to be perforation of the colon, which is instantly recognized by the contents of the syringe after a biopsy.
Fine needle aspiration BP (FNA) under ultrasound or CT guidance
This type of biopsy is used to obtain material for cytological examination if a malignant tumor is suspected. In addition, this study is carried out if the patient has been diagnosed with vascular or echinococcal lesions of the liver.
For the procedure, the patient is asked to lie on his back or on his left side. The puncture site is treated with an antiseptic and local anesthesia is performed. Using ultrasound or CT data, a puncture trajectory is outlined, after which a pinpoint incision is made with a scalpel. The needle is inserted under ultrasound guidance. When it reaches the required area, a syringe is connected to the needle and tissue is taken. After that, the needle is removed, the puncture site is treated with an antiseptic and a bandage is applied. Before transporting the patient to the ward, a second ultrasound is performed.
Transjugular (transvenous) biopsy
This method of research is usually used when the patient is diagnosed with ascites. Also, this method is recommended for reduced blood clotting – in this case, the puncture or laparoscopic method of biopsy is fraught with the development of bleeding. Also indications for choosing this particular research method are obesity and vascular tumors.
As a rule, the procedure takes from half an hour to an hour. The patient is asked to lie on his back and electrocardiographic monitoring is performed. After treating the neck area with an antiseptic, local anesthesia is performed. The next step is to make a small incision over the jugular vein and insert a vascular catheter into it. The catheter moves to the liver under the control of X-ray equipment. When it passes through the right atrium, there is a risk of developing an arrhythmia. Next, the catheter moves along the inferior vena cava to the right hepatic vein. When it reaches the required point, a special needle is inserted into the catheter and a biopsy is performed. At this point, many patients complain of pain in the right shoulder or under the ribs. After the material is obtained, the catheter is removed from the jugular vein, the wound is treated with an antiseptic and a bandage is applied. After that, the patient is transferred to the ward.
Contraindications for this procedure are bacterial-type cholangitis, the presence of cystic liver lesions, and hepatic vein thrombosis.
If we talk about the possible complications of transvenous biopsy, then in the case of perforation of the liver capsule, massive intraperitoneal bleeding may develop.
In addition, in very rare cases, pneumothorax and dysphonia may develop.
Laparoscopic biopsy
Laparoscopic biopsy can be performed during general laparoscopic diagnosis or laparoscopic surgery. This diagnosis is carried out under general anesthesia. The doctor makes small incisions on the skin of the abdomen, through which a fiber-optic probe equipped with lighting with a video camera and special surgical instruments are inserted into the abdominal cavity. The camera transmits an image to the screen, guided by which the surgeon takes a tissue sample using special forceps or a loop. After the biopsy, the tissues are cauterized to stop the bleeding. After removing the instruments and the laparoscope, the wounds are treated and bandaged.
This type of diagnosis is carried out in order to determine the stage of tumor growth, with peritoneal infection.
This procedure is not recommended for severe heart and respiratory failure, with peritonitis of bacterial origin, as well as in case of intestinal obstruction. The procedure is complicated with severe obesity, as well as with a hernia of the abdominal wall.
Possible complications of laparoscopic biopsy can be quite serious and include rupture of the spleen, severe pain, and hematoma of the anterior abdominal wall.
Incisional liver biopsy
During surgery, an incisional biopsy may be performed. Organ tissue is excised and sent to the laboratory. In the event that the result of the analysis is needed before the completion of the surgical intervention, the operation is suspended until a response is received.
Preparing for the procedure
In order to avoid the development of complications during a liver biopsy, you should properly prepare for the procedure. Usually the doctor instructs the patient on what measures to take.
First of all, a week before the procedure, it is recommended to stop taking non-steroidal anti-inflammatory drugs. In the event that you are taking anticoagulants, you should definitely notify your doctor about this.
Three days before the diagnosis, you need to review your diet. Excluded should title=””be products that can provoke flatulence. These are black bread, milk, raw vegetables and fruits. It is also recommended to take enzymes and drugs that prevent gas formation.
On the eve of the procedure, the last meal should be no later than 21:00. Dinner should be very light. On the day of the procedure, a general blood test and a control ultrasound are performed. A liver biopsy is performed exclusively in the morning, on an empty stomach.
How to behave after the procedure
During the day after any type of biopsy, doctors recommend bed rest. Within two hours after the procedure, you should lie on your right side for at least two hours. An ice pack may be applied to the biopsy site. Every two hours, patients have their blood pressure measured and their heart rate monitored. Eating is allowed no earlier than three hours after medical procedures.
As a rule, patients are discharged from the hospital within a day after those types of biopsy that are considered minimally invasive. Doctors recommend at least two days after the procedure to refrain from physical activity. Within a week after the biopsy, you should stop taking drugs containing Aspirin, as well as anti-inflammatory drugs. In addition, thermal procedures are not allowed.