Liver Biopsy

Liver biopsy is not necessary for diagnosis, but it is helpful for grading the severity of disease and staging the degree of fibrosis and permanent architectural damage. Hematoxylin and eosin stains and Masson's trichrome stain are used to grade the amount of necrosis and inflammation and to stage the degree of fibrosis. Specific immunohistochemical stains for HCV have not been developed for routine use. 


Liver biopsy is also helpful in ruling out other causes of liver disease, such as alcoholic liver injury or iron overload.

HCV causes the following changes in liver tissue:

Necrosis and inflammation around the portal areas, so-called "piecemeal necrosis."

Necrosis of hepatocytes and focal inflammation in the liver parenchyma.

Inflammatory cells in the portal areas ("portal inflammation").

Fibrosis, with early stages being confined to the portal tracts, intermediate stages being expansion of the portal tracts and bridging between portal areas or to the central area, and late stages being frank cirrhosis characterized by architectural disruption of the liver with fibrosis and regeneration.

Grading and Staging of hepatitis by assigning scores for severity are helpful in managing patients with chronic hepatitis. The degree of inflammation and necrosis can be assessed as none, minimal, mild, moderate, or severe. The degree of fibrosis can be assessed similarly. Scoring systems are particularly helpful in clinical studies on chronic hepatitis.

tags:Liver biopsy,HCV liver,Grading and Staging of hepatitis ,chronic hepatitis.the liver parenchyma

Liver Biopsy Part II

A liver biopsy is a procedure for the diagnosis of abnormal liver conditions.

There are several methods of obtaining biopsies of the liver, but unless it is an unusual situation, the most common method is percutaneously ("through the skin"). A percutaneous biopsy involves numbing a small area of skin over the lower right side of the chest (this site is directly over the liver).

A local anesthetic (usually Lidocaine or Novocaine) is injected with a needle. The needle is introduced further with additional injections of anesthetic all the way through the chest wall and into the liver. This numbs the tract that the biopsy needle will take and reduces discomfort.

Next, a special biopsy needle is inserted into the same area, and, with the patient holding his or her breath, the biopsy needle is inserted quickly into the liver and withdrawn. (The insertion and withdrawal of the biopsy needle takes only a second or two.) Suction through the needle, applied via an attached syringe, causes a small piece of liver (the biopsy) to be pulled into the needle and cut off from the rest of the liver. Other types of biopsy needles have a spring loaded cutting mechanism to obtain the liver tissue without the use of the syringe suction.

If there is a question about the exact position of the liver or a specific part of the liver is to be biopsied, an ultrasound of the liver may be performed before the biopsy to determine the exact direction for the biopsy needle to be inserted.

There may be varying amounts of discomfort at the site of the biopsy especially after the effect of the anesthetic wears off. Most patients have minimal pain, but some require medication for pain which lasts up to a few hours.

What are possible complications of a liver biopsy?

The most common complication of liver biopsy is bleeding from the liver at the site of the biopsy. This occurs in approximately one out of every 100 patients who are biopsied. The bleeding usually (50-75% of the time) is not heavy enough to require blood transfusions. In rare cases (less than 1 biopsy in a thousand), the bleeding may not stop and surgery is required to stop it. Fatal complications have been reported in up to 0.038% of biopsied patients.

tags:Liver Biopsy,complications of a liver biopsy,hepatitis B,C