Liver biopsy
A biopsy means removing a sample of cells or tissue and looking at it under a microscope. You may have a liver biopsy to help diagnose liver cancer. But not everyone needs to have one. Doctors can often diagnose liver cancer just by looking at the scans.
You usually won't have a liver biopsy if your doctor thinks:
- they can remove the cancer
- you may be able to have a liver transplant
This is because there is a small risk that a liver biopsy could spread the cancer along the path of the biopsy needle. It is important to avoid this if the cancer hasn't already spread. Your doctor can confirm the diagnosis after surgery.
You may also need to have a liver biopsy if your doctors think you have secondary liver cancer. Secondary liver cancer means that a cancer that started somewhere else in the body has spread to the liver.
Before your liver biopsy
You’ll be given written instructions on how to prepare for your liver biopsy. For example, they might ask you not to eat and drink for a few hours before the test.
You usually have a blood test beforehand to check your blood levels and how well your blood clots.
Tell your doctor if you're having medicine that changes how your blood clots. This includes:
- aspirin
- clopidogrel
- arthritis medicines
- warfarin or heparin
- apixaban or rivaroxaban
- ticagrelor
Your doctor will tell you if you need to stop taking these or any other medicines for a while before your biopsy.
How you have a liver biopsy
There are several different ways that your doctor can take samples from your liver:
Through the skin on your side (percutaneous biopsy)
Percutaneous means through the skin. Your doctor (
) takes a sample of liver tissue by passing a needle through your skin into the liver. First, they clean the area with antiseptic solution. They then inject some into the area over your liver so you can't feel anything.
Your radiologist then puts a special needle in through the skin into your liver. This is usually on your right side, between or just below your ribs. They use ultrasound or CT scans to help guide the needle into the right place. They take a sample of tissue and send it to the laboratory for a to look at. At the end of the test they remove the needle and cover the area with a small dressing.
Through a vein in your neck (transjugular biopsy)
A transjugular biopsy is less common than a percutaneous biopsy. Your doctor takes the liver sample through a vein in your neck. For this test, you might have a local anaesthetic. Or you sometimes have a drug to help relax you (sedation).
Your doctor (radiologist) cleans the right side of your neck with an antiseptic solution. They then inject a local anaesthetic to numb the area. Your doctor puts a thin tube (catheter) into a vein in your neck. They move the catheter down into the veins of your liver using x-rays to help guide them.
Your radiologist removes a small piece of tissue from your liver. They send this to a laboratory for a pathologist to look at. At the end of the test, they remove the catheter and put a small dressing over the area.
Keyhole surgery (laparoscopy)
Laparoscopy is a small operation to look inside your tummy (abdomen). Your surgeon can closely examine your liver and the surrounding area. They can look for any signs of cancer and whether it has spread.
You have the operation while you are asleep (under general anaesthetic). Your surgeon usually makes some small cuts in your tummy (abdomen):
- one in or near your tummy button
- on one or both sides of your upper abdomen
Your surgeon puts a thin tube with a light and camera (laparoscope) through one of the cuts. They can see the pictures on a TV screen. They put surgical instruments through the other cuts.
They can take samples of tissue (biopsies) and fluid to send to the laboratory. The pathologist looks for cancer cells and to see whether the rest of your liver is healthy.
After the test
You need to stay in bed for about 6 hours after a liver biopsy. There is a risk of bleeding afterwards and your doctor will want to keep an eye on you. You may need to stay in hospital overnight. If you can go home, you will need someone to stay with you overnight.
Getting your results
Before you leave hospital make sure you know how you will get the results. You may be asked to return to the hospital for an outpatient appointment to get the results. Or the results may be sent in the post.
Waiting for test results can be a very worrying time. You might have contact details for a specialist nurse who you can contact for information if you need to. It can help to talk to a close friend or relative about how you feel.
You can also contact the Cancer Research UK information nurses on freephone 0808 800 4040 for information and support. The lines are open from 9am to 5pm, Monday to Friday.
Contact the doctor who arranged the test if you don't hear anything.
