Norm of Liver Biopsy (Percutaneous Liver Biopsy)
Normal liver cells and tissue. Negative for malignancy, fibrosis, inflammatory infiltrates, Mallory's hyaline, and steatosis.
Usage of Liver Biopsy (Percutaneous Liver Biopsy)
Used in the past to diagnose liver disease. Today is used primarily to determine prognosis for liver disease and monitor client response to treatment after imaging and serologic testing have confirmed the diagnosis of hepatitis C and other liver disease. Fine-needle aspiration biopsy is the diagnostic procedure of choice for evaluation of liver lesions. Almost all fine-needle aspiration biopsies of the liver use interventional radiology, primarily ultrasonography and computed tomography. Used when the diagnosis or cause cannot be established by other means. Also indicated to evaluate liver transplant allografts.
Description of Liver Biopsy (Percutaneous Liver Biopsy)
A liver biopsy is a relatively safe, simple, and valuable method of evaluating pathologic liver conditions. After the client is given local anesthetic, and while using an aseptic technique, a needle is inserted through the abdominal wall to the liver (percutaneous approach). Liver tissue is obtained by the needle biopsy for microscopic examination. The transjugular, laparoscopic, or intraoperative approaches may also be used. Liver biopsy may be performed in conjunction with ultrasound or computed tomography guidance.
Professional Considerations of Liver Biopsy (Percutaneous Liver Biopsy)
Consent form IS required.
Follow-up studies have indicated a very low rate of serious complications (0.06%–0.32%) manifesting as pain, hemorrhage (1%–5% risk), bile peritonitis, liver cyst, penetration of abdominal viscera, and pneumothorax. Mortality is rare (0.006%–0.1%). The estimated rate of needle-tract seeding is small in fine-needle aspiration of the liver. Only three cases reported.
Uncorrectable bleeding diathesis. Prothrombin time in the anticoagulant range (2–3 seconds over control values); platelet count less than 50,000/mm3; other bleeding disorders; anemia and inability to tolerate major blood loss associated with inadvertent puncture of an intrahepatic blood vessel; pronounced ascites; obstructive jaundice caused by a possible bile leakage; infection of the biliary tract; infection in the right pleural space or right upper quadrant of the abdomen; a hemangioma; or an inability to cooperate during procedure (such as remaining still and holding the breath during sustained exhalation). Sedatives are contraindicated in clients with central nervous system depression. See also Computed tomography of the body if CT will be used.
See also Computed tomography of the body if CT will be used .
- Obtain a biopsy tray, sterile gloves, slides, sterile sponges, and tape for dressing.
- Ensure that all coagulation tests are normal.
- Administer any sedative medications as prescribed.
- A CT scan may need to be scheduled if the biopsy needle must be inserted under CT guidance to obtain tissue from a specific area of the liver.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The area of the liver suspected of being abnormal is noted.
- The client is placed in the supine or left lateral position.
- The skin area used for puncture is anesthetized locally.
- The client is asked to exhale and hold the inhalation so that the liver descends and the possibility of a pneumothorax is decreased.
- The biopsy needle is inserted by the physician into the liver during the client's sustained exhalation, and a liver tissue is obtained.
- The needle is withdrawn from the liver.
- A pressure dressing is applied.
- The procedure takes approximately 30 minutes.
- Touch-prints on glass slides may be made before fixation and may be submitted for cytologic evaluation.
- Needle rinses in 50% alcohol or saline may also provide helpful diagnostic material.
- Direct slides from needle aspirates may be made, and the slides may be fixed immediately in 95% alcohol.
- Tissue samples may be placed into a specimen bottle containing 10% formalin for fixation.
- Send the specimens to the pathology department.
- Assess vital signs frequently (every 15 minutes × 2) to determine evidence of hemorrhage (increased pulse rate and blood pressure) and peritonitis (increased temperature).
- Assess the biopsy site for bleeding.
- Place the client on the right side for 1–2 hours after the procedure. This position will compress the liver against the chest wall and will decrease the risk of hemorrhage or bile leak.
- Bed rest with 24-hour observation after the biopsy is usually prescribed. Some studies have found no increase in adverse outcomes when discharging clients with no complications 1 hour after fine-needle aspiration liver biopsy.
Client and Family Teaching
- Explain the purpose of the procedure.
- Fast from food and fluids after midnight on the day of the test.
- The procedure takes about 30 minutes. Local anesthetic is used to control pain.
Factors That Affect Results
- False-negative results may occur, and localized liver disease may be missed, because a very small fragment of liver tissue, which is often partially destroyed, is taken in a random manner from a large organ. False-negative results may be attributable to (1) sampling error, because the detection rate of liver metastasis is approximately 60% with blind biopsy and about 85% using ultrasound guidance, and (2) degeneration or distortion, which has been caused by faulty preparation of the specimen.
- False-positive results may be attributable to incorrect interpretation of very reactive hepatocytes.
- An experienced gastroenterologist or radiologist should perform the procedure.
- Specimens for histologic and cytologic examination may be obtained using ultrasound radiologic guidance and a tissue-core biopsy needle, such as the Menghini needle. Specimens for cytologic examination may be obtained only by use of a fine-aspirate needle.
- Detection of portal vein tumor invasion in clients with hepatocellular carcinoma is important to determine therapy and prognosis. Fine-needle aspiration of a portal vein thrombus under ultrasonographic guidance helps to distinguish malignant from benign thrombus without resorting to laparotomy.
- See also Hepatic function panel—Blood.