A liver biopsy is done using a needle inserted between
two of the right lower ribs to remove a sample of liver tissue. The tissue
sample is sent to a laboratory and looked at under a microscope to see if there
are any liver problems.
Find the cause of jaundice. A liver biopsy can
find certain liver diseases (such as cirrhosis), infections (such as
hepatitis), and liver tumors.
Find the cause of abnormal blood test
results from aspartate aminotransferase (AST) and alanine aminotransferase
(ALT) tests. Both ALT and AST levels show liver damage and can help confirm
See how much the liver is inflamed or scarred by
hepatitis or other liver diseases.
response to treatment for liver disease.
Determine whether a
medicine, such as methotrexate, is causing a toxic effect on the
Check the function of a transplanted liver.
the cause of an unexplained and ongoing fever.
Check a liver mass
found on an X-ray, ultrasound, or CT scan.
How To Prepare
Before you have a liver biopsy, tell
your doctor if you:
Are taking aspirin,
nonsteroidal anti-inflammatory medicines (such as
ibuprofen or naproxen), or a blood thinner. You may be asked to stop taking these
medicines at least 1 week before the test to lower the chance of bleeding after
Have recently had
pneumonia, which may make it hard to do this
Have a history of fluid buildup in the belly (ascites). Ascites may make it hard to do this
If you take insulin, check with your doctor about what you
need to take on the day of your test.
be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Arrange for someone to drive you home
after the test because you may be given a sedative to help you relax.
You will have
blood tests done before the liver biopsy to see whether you have any bleeding
or blood clotting problems. You may also have an ultrasound test or CT scan of
the liver to check the best place to insert the biopsy needle.
Follow the instructions exactly about when to stop eating and drinking. If you don’t, your procedure
may be canceled. If your doctor told you to take your medicines on the day of the procedure, take
them with only a sip of water.
Talk to your doctor about any
concerns you have regarding the need for the test, its risks, how it will be
done, or what the results will mean. To help you understand the importance of
this test, fill out the medical test information form(What is a PDF document?).
How It Is Done
A liver biopsy is done by a gastroenterologist, hepatologist, radiologist, or
surgeon in a clinic or a hospital. A liver biopsy is
often done by a radiologist using ultrasound or a CT scan to help guide the
biopsy needle. When cirrhosis of the liver or a cancer is suspected, a liver
biopsy may be done during a laparoscopy.
You will need to take off
all or most of your clothes. You will be given a cloth or paper gown to use
during the test.
Before the test, you may be given a sedative
through a vein (IV) in your arm. The sedative will help you relax and
During the test
During the test, you will lie on your back with your right arm
resting under or above your head and your head turned to your left. Your doctor
may tap on your chest and belly to find your liver or he or she may use
Your doctor will mark a spot between two of your right
lower ribs where the biopsy needle will be inserted. The site will be cleaned
with a special soap and draped with sterile towels. The doctor will give you a
medicine (local anesthetic) to numb the area where the biopsy
needle will be inserted.
You may be asked to take a deep breath,
blow all the air out, and then hold your breath while the biopsy needle is
being inserted and withdrawn. This will take only a few seconds. Holding your
breath lowers the chance that the needle will go in your lung since the lungs
are very close to the liver. It is important to remain still during the few
seconds it takes for the doctor to collect the tissue sample. The doctor may
take another tissue sample from the same spot, but from a different
As soon as the doctor removes
the needle, you can breathe normally. A bandage will be put on the puncture
site. The test generally takes 15 to 30 minutes.
After the test
You will rest in
bed and lie on your right side for 2 to 6 hours after the test. Your pulse,
blood pressure, and temperature will be checked often after the biopsy.
You can go home if you have no problems after the test. You may eat your
regular diet. But unless your doctor tells you it is okay, do not take aspirin,
nonsteroidal anti-inflammatory medicines, or blood thinners for one week after the biopsy. You may do your regular activities,
but do not do strenuous activities or heavy lifting until your doctor says it
How It Feels
You may feel a brief sting or burn when
the numbing medicine (anesthetic) goes in your skin. When the biopsy needle is
inserted, you may again feel a sharp pain for a few seconds.
may feel deep pressure and a dull pain in your belly when the biopsy needle is
inserted. After the anesthetic wears off, you may feel a dull pain in your
right shoulder. This is called referred pain and generally goes away in about 12
hours. You can take a nonprescription medicine, such as acetaminophen
(Tylenol), for the pain. Call your doctor if your pain gets worse or lasts
longer than 2 days.
A small amount of bleeding from the biopsy
site can be expected. Ask your doctor how much drainage to expect.
Serious problems from a liver biopsy are rare. Problems can include:
Bleeding, which may need blood transfusions or
surgery to correct.
After the test, call your doctor immediately if you
A lot of bleeding from the needle
A fast or skipping heartbeat.
Increasing pain at the needle site.
Swelling or bloating in your belly.
A liver biopsy is done using a needle inserted
between two of the right lower ribs to remove a sample of liver tissue. The
tissue sample is sent to a laboratory and looked at under a microscope to see
if there are any liver problems.
Samples of liver tissue sent to a pathology lab
will be looked at under a microscope for liver diseases such as liver cancer or cirrhosis.
Other samples of liver tissue
may be sent to a microbiology lab to see whether an infection, such as tuberculosis of the liver, is present.
Test results are generally ready in 2 to 4 days. If tests
are done to find infections, it may take several weeks for the results to be
The liver tissue looks normal under a microscope. No
signs of infection, inflammation, cancer, or cirrhosis are present.
Abnormal cells or liver tissue are present. This may be
caused by an infection such as hepatitis, liver disease such as cirrhosis, or cancer. If liver cancer is present, the biopsy can help find the
type of cancer. If
hepatitis is present, the test can be used to see the
chance of developing cirrhosis. Test results may also show the severity of
What Affects the Test
Occasionally, a liver biopsy may not provide helpful results because not enough tissue is sampled
to make a clear diagnosis.
What To Think About
Aspartate aminotransferase (AST) and alanine
aminotransferase (ALT) are blood tests done to check liver function. Both ALT
and AST levels show liver damage and may be done to help diagnose liver
disease. A liver biopsy may be done when AST and ALT levels are very high and
no other reason for high levels is found.
biopsy should not be done on people who have bleeding or blood clotting
problems, or certain types of infections.
A transvenous liver
biopsy is another method that may be used. During this test, a radiologist inserts a thin tube
(catheter) into a neck vein, which is guided to the liver. A sample can be taken
through the catheter.
If a larger sample of liver tissue is needed,
an open biopsy of the liver may be done at another time, using surgery or
laparoscopy. A liver biopsy is sometimes done at the
same time as another abdominal surgery. To learn more, see the topic Laparoscopy.
Other Works Consulted
Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Martin J. Gabica, MD – Family Medicine Specialist Medical ReviewerMichel M. Murr, MD – General Surgery, Bariatric Surgery