What is a liver biopsy?

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A liver biopsy allows a doctor to look at a sample of liver tissue under a microscope, helping to detect unusual changes in the liver from conditions such as liver disease or liver cancer.

It can also help a doctor distinguish several potential causes of liver health issues. For example, a doctor might use a liver biopsy to determine whether a person has nonalcoholic fatty liver disease or autoimmune hepatitis.

More than 95% of people who undergo a liver biopsy have a successful test. The overall complication rate is low, at about 1%, with a death rate of 0.2%.

Still, it is not a risk-free procedure, so people should discuss the risks and benefits of the test with healthcare professionals — especially older adults and people with health conditions.

The most common complications of a liver biopsy test are:

• pain after the procedure, which most people experience
• bleeding, which is rare in people with cancer (0.57%), and rarer in those without cancer (0.16%)
• bacteria in the bloodstream, which usually resolves on its own
• serious bacterial infection in the liver or surrounding areas
• very rarely, complications such as heart injuries or a collapsed lung

A person will need blood tests within a month of a liver biopsy to assess whether they have any conditions that increase their risk of bleeding or other complications. They should inform a doctor about their current medications or supplements and continue taking them daily unless a doctor advises otherwise.

Doctors usually advise stopping taking aspirin, blood thinners, and nonsteroidal anti-inflammatory drugs (NSAIDS) 1 week before a biopsy. These can increase the risk of bleeding. They may also instruct a person not to eat or drink anything after midnight the night before the procedure.

A person may feel groggy from the sedation after a liver biopsy, so they must arrange for someone else to drive them home.

Doctors perform three different types of liver biopsies, as follows:

Percutaneous liver biopsy

A percutaneous liver biopsy is the most common approach to liver biopsy. During the procedure, a person is awake, and a doctor inserts a needle through the skin and liver to get a tissue sample. A doctor may locate the liver by feeling for it under the skin or by using an ultrasound machine.

A doctor injects lidocaine into the area around the liver. They make a tiny incision along the ribs, then insert a needle into the incision. A doctor may give directions during the procedure. For example, a person may need to hold their breath briefly when the needle goes in.

Most people do not feel pain, but they may feel a dull ache or shoulder pain.

Transvenous liver biopsy

A transvenous liver biopsy allows doctors to access the liver via a vein rather than inserting the needle directly into the skin. It may reduce the risk of complications in people with some medical conditions. A person usually has the procedure while sedated but conscious.

First, a doctor numbs the area where a needle will enter a blood vessel. Then, they insert the needle into a blood vessel, often in the neck. Using a fluoroscope machine that provides images of the inside of the body, a doctor slowly moves to the liver, then takes a sample.

Laparoscopic liver biopsy

Doctors typically perform a laparoscopic liver biopsy in an operating room on a person under general anesthesia. However, a doctor may perform this as an outpatient procedure with moderate sedation.

A doctor makes a small incision into a person’s abdomen and obtains a liver sample. Doctors typically perform a laparoscopic liver biopsy while already performing another surgical procedure. They may also recommend it in people with chronic liver disease.

People often worry about pain during a liver biopsy. In most cases, a person only feels a brief prick from the needle a doctor uses to numb the area and not intense pain. When the area goes numb, it may feel tingly.

A person who has a laparoscopic procedure will not feel anything after a doctor gives them anesthesia.

After the procedure, a person may have some aching or pain, but the pain should not be intense or unbearable.

Regardless of the type of liver biopsy a person has, guidelines from the American Association for the Study of Liver Diseases recommend they remain in the hospital or doctor’s office for 2–4 hours afterward for observation. Most complications occur in the first 1–3 hours following a biopsy, though they can happen up to 24 hours later.

A person should call a doctor if they have intense pain, feel very weak, or feel very sick. Before the test, they should ask a doctor what signs and symptoms indicate an emergency.

A normal liver biopsy shows:

• no signs of scarring or fibrosis in the liver
• no significant fat accumulation in the liver
• no signs of cancer or abnormal cell growth
• no inflammation or signs of the hepatitis virus
• no abnormal levels of copper, which could indicate Wilson’s disease

Abnormal liver biopsy results may provide evidence for several different diseases, such as:

• liver cirrhosis
• liver cancer
• autoimmune hepatitis
• viral hepatitis
• Wilson’s disease
• nonalcoholic fatty liver disease

Learn more about liver biopsy results here.

A liver biopsy can help diagnose several medical conditions and may help distinguish one from another. A doctor may recommend it if a person has an abnormal liver ultrasound, abnormal liver blood work, or significant risk factors for liver cancer or other serious liver diseases.

People considering a liver biopsy should discuss the risks and benefits with a doctor and ask about alternatives. For most people, a liver biopsy is a safe procedure and unlikely to cause severe pain.