What is a percutaneous liver biopsy?

A liver biopsy is a medical procedure that involves using a special needle to take a small sample of tissue from your liver for examination under a microscope. The biopsy is done through the skin, so this procedure is called a percutaneous biopsy.

Why do I need to have a percutaneous liver biopsy?

The decision that you need a liver biopsy made by the consultant looking after you, usually a hepatologist (liver specialist.)

  • Looking at the sample of liver tissue taken during a biopsy gives your doctor more information about your liver that cannot be obtained from scans or blood tests.
  • Sometimes a liver biopsy may be the only way to get the information needed to make a correct diagnosis and treat your illness.

Alternatives to a liver biopsy

There is no other procedure which will give your doctors the same information as a liver biopsy.

Before your procedure

You will need to have a blood test before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy.

You can continue taking your normal medications unless your doctor or nurse tells you not to. If you are on any medication which thins the blood (e.g., aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) please telephone the interventional radiology department at the Royal Free Hospital on 020 7433 8772 as we may need to adjust your medication before undergoing this procedure.

For morning admissions, please do not eat or drink anything from 12 midnight – you can drink water for up to two hours before the procedure.

For afternoon admissions, you may eat a light breakfast but please do not eat or drink anything after 6am – you can drink water for up to two hours before the procedure.

During the procedure

A specially trained doctor called a radiologist will perform the biopsy. They have special expertise in using imaging for diagnosis, to perform procedures and administer treatment.

  • You will attend PITU (planned investigation and treatment unit) at the time on your appointment letter.
  • You will be asked to change into a hospital gown and a cannula inserted.
  • A cannula is a small tube inserted into a vein which enables us to give you medication into a vein if needed.
  • A porter will then take you to the interventional radiology department for the procedure.
  • You will be asked to give written consent before the procedure. We want to involve you in decisions about your care and treatment – please do not hesitate to ask the doctor if you have any questions at all. It is your decision to have the procedure.
  • The procedure will involve you lying flat on a trolley.
  • The doctor will use an ultrasound scanner to decide on the best place to insert the needle to take the biopsy. They will then inject local anaesthetic to numb the area and will then insert the biopsy needle and take the sample. You may be asked to hold your breath for a short time whilst the biopsy needle is inserted.
  • The sample will then be sent to the lab for examination under a microscope.
  • Usually, the procedure will take about 30 minutes.

After your procedure

  • You will be observed for a short time in the Interventional Radiology department before being taken back to a ward where you will need to stay in bed as instructed by the nursing staff, usually for six hours. They will monitor you at regular intervals.
  • You may experience some pain after the biopsy for which you can be given painkillers.
  • Once you have been observed for a satisfactory length of time you will be discharged and be able to go home the same day.
  • Someone will need to take you home by car or taxi. Public transport is not recommended as it is not safe should you feel unwell.

When you get home

  • You should rest for the remainder of the day, do not go back to work that day.
  • You should not drive any vehicles or operate heavy machinery on the day of the biopsy.
  • You may experience pain on your right side where the biopsy was taken or in your shoulder. This should be controlled with regular painkillers and settle within two days.
  • You can eat and drink as normal.
  • You should not get your dressing wet for 24 hours.
  • If you experience any symptoms such as chills, high fever, difficulty breathing, excessive bright red bleeding from the biopsy site, severe chest, shoulder or abdominal pain, passing blood in your poo, or increasing abdominal swelling, please attend your nearest A&E department.

When will you receive your results?

Once the biopsy has been examined under the microscope the doctor who referred you for the liver biopsy will receive the results.

They may a letter to explain these results to you and your GP or discuss them with you in person at your next appointment.

Risks and side-effects

Percutaneous liver biopsy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.

Occasionally people will experience aching or pain on their right-hand side or right shoulder. This is caused by bruising around the biopsy site and it is not serious or dangerous. This can usually be controlled with over-the-counter painkillers.

Rarely, more significant complications can, and these include:

  • Bleeding from the biopsy site.
  • Puncturing the lining of the lung.
  • Injury to internal organs close to the liver.

The chance of each of these complications is fewer than 1% (this figure has been taken from national and international research) and the risks are minimised by using an ultrasound scanner to choose the location for the biopsy.