Liver Biopsy
This procedure is regarded as the most reliable test currently available to assess the current health of the liver. A liver biopsy used to be a requirement for people considering treatment but this is no longer
the case.
A biopsy is a minor surgical procedure in which a specialist takes a tiny piece of the liver for laboratory examination. Your specialist may have specific reasons for recommending that you have a liver biopsy.
Other non-surgical options for assessing liver damage are currently being researched and may become available in the near future. The decision to have a liver biopsy should not be taken lightly. While it is generally considered a safe procedure, there is always the risk of bleeding or other more serious complications. For this reason, other techniques may be used for assessing liver damage in people with haemophilia or other blood clotting conditions.
Nowadays it is generally standard procedure that an ultrasound or CT scan is used to pinpoint an appropriate site for the biopsy. This minimises the risk of complications such as causing too much bleeding or missing the liver. People considering a liver biopsy may wish to check that an ultrasound or scan will be performed. Liver biopsies usually involve the following:
• A single day admission to hospital
• The skin is sterilised and a local anaesthetic is administered
• A very small needle is passed between the ribs and into the liver
• A thin matchstick size sample of the liver is removed
• The patient is required to lie still for at least four hours after the procedure to minimise the risk of bleeding.
While for many people the operation is pain free, others experience some discomfort. Some people, for example, experience a pain in the right shoulder that makes it difficult to lie still after the procedure. Some people also experience pain at the site of the biopsy and others report a temporary feeling of being unwell during and after the biopsy. For many people, painkillers may be necessary after the procedure in order to decrease discomfort.
A liver biopsy tests for both damage to the liver (described as the amount of fibrosis) and the extent of the inflammation (often differentiated according to parts of the liver, as either lobular or portal inflammation). The amount of fibrosis can also be referred to as the stage of the liver damage and the
extent of inflammation as the grade.
Specialists often use different scales for measuring biopsy results, though it is common to use a tool that measures fibrosis and inflammation separately. Scales include the Metavir, Modified Knodell and the Scheuer. All these work on the same principles but use different grading systems, so it is important to know which scale is being used. Scales generally use progressive numbering systems to denote the extent of damage and/or inflammation present in the liver. Progression of liver damage from one
stage to another (graded 0 - 4, with 4 being the most severe) varies from person to person, depending on many factors including overall health. The rate of progression is not even or linear and progression from one stage to another may occur over just a few years or take 20 years or more.
A doctor should explain the purpose of the test, the possible implications of a positive or negative result and follow-up care and support options.
Source - Impact booklet, produced by Hepatitis C Victoria, June 2008