Liver Biopsy

Chronic hepatitis C virus (HCV) can damage the liver. This damage leads to other health issues. There are invasive and non-invasive tests to look at the liver.

Non-invasive tests include blood tests and ultrasound imaging. Non-invasive tests are usually preferred unless invasive testing is needed. One invasive test used to look at damage from HCV is a liver biopsy.^1-3

What is a liver biopsy?

A biopsy involves taking a small piece of tissue from the body. During a liver biopsy, a very small sample of the liver is collected with a special needle.

Then the sample is examined under a microscope. Doctors can then see if the liver is damaged and how severe the damage is. They can also run lab tests on the tissue to look for other health conditions that might affect the liver.^4,5

Most liver biopsies are percutaneous, meaning that the needle goes through the skin near the liver. There are other ways to send the needle to the liver, but these are less common. Your doctor will tell you before your biopsy which type you are having.^4,5

It may be possible to assess liver damage through blood tests and imaging alone. But you may need a liver biopsy if these other tests are not clear. You may also need a liver biopsy if your doctor thinks you may have another liver-related condition.^1-3

Liver biopsies and hepatitis C

A liver biopsy is a type of surgery to check the health of your liver. It is a test done if noninvasive methods are inconclusive.¹

Damage can be classified as fibrosis and cirrhosis. Fibrosis is reversible damage and cirrhosis is permanent scarring. There are staging systems your doctor can use to determine how severe your damage is and what other issues you might be at risk for. Figuring out what stage your liver damage has gotten to can help you and your doctor decide the best treatment options, dosage, and follow-up times for you.^6,7

The amount, type, and location of damage can help predict how your HCV might behave in the future. For example, people who have more inflammation and fibrosis are more likely to progress to cirrhosis. People whose inflammation gets better after starting treatment have less risk of progressing to cirrhosis.¹

Preparing for a liver biopsy

Before a liver biopsy, your doctor may do blood tests. This is to determine your risk of bleeding with the procedure. Some drugs can increase the risk of bleeding, and you may be asked to stop them in advance. These include drugs that reduce clotting like warfarin or other blood thinners. Aspirin, ibuprofen, and some supplements can impact bleeding risk and may need to be stopped as well. Tell your doctor about all drugs and supplements you take before scheduling your biopsy.^4,5

You may need to stop eating a few hours before the biopsy. In addition, you may need a ride home if any sedative drugs are used. Your doctor will let you know ahead of time what specific things you need to do. Most people will not be allowed to lift anything that weighs 10 pounds or more after the biopsy. This restriction usually lasts about a week.^4,5

What to expect during a liver biopsy

During the biopsy, you may have an intravenous (IV) line placed to deliver drugs or fluid if needed. In a percutaneous biopsy, your doctor will have you lie on your back. They will look for your liver. Then they will have you lift your arm above your head and will insert the needle into the back or side of your belly. Some doctors use imaging like ultrasound to guide the needle in.^4,5

After the biopsy, you will be taken to a recovery room. Biopsies can be done in the hospital or at offices that do outpatient procedures. Most people go home the same day after a few hours of monitoring. The results of a liver biopsy are not immediate. Your doctor will discuss your results with you in a few days.⁴

Risks of liver biopsy

There are some people who cannot have a liver biopsy. These include people with bleeding or blood clotting problems. Other health conditions can also impact your ability to get a liver biopsy. Talk with your doctor about all the health issues you have beforehand.^4,5

The most common side effect after a liver biopsy is pain. Many people also experience anxiety before the biopsy. Your doctor may recommend an anxiety or sedative drug for you to take before or during the procedure. Serious risks of a liver biopsy are infection or damage to nearby organs, but these are rare.^4,5