The Truth Will Set You Free .....
Processing of Liver Biopsy Specimen
The biopsy specimen is processed by the pathologist in order to view it microscopically. Overall changes in the normal liver architecture and evidence of inflammation can be seen with normal processing. Special stains can also be employed to diagnose specific illnesses. The pathologists, surgeons and hepatologists review the biopsy results together and decide upon appropriate treatment or additional diagnostic procedures.
Why are Liver Biopsies Performed?
The two most common reasons for liver biopsy are to diagnose a mass or tumor seen on imaging studies and to gauge the severity of tissue injury in diseases such as Hepatitis C Virus infection. Another indication is in diagnosing rejection or infection in patients who have had liver transplants.
Imaging studies such as ultrasound, CT scan and MRI can detect abnormal masses in the liver and both CT and MRI can definitively diagnose liver cancer (hepatocellular carcinoma) if certain criteria are met. If the diagnosis is unclear on imaging studies, that is, if there is a doubt if the mass appears benign or malignant, then biopsy should be performed to confirm the diagnosis and to direct appropriate therapy. Biopsy should not routinely be performed on liver masses that meet definitive imaging characteristics for cancer (e.g. arterial enhancement and venous “wash out” of the lesion on dynamic imaging and the presence of underlying liver disease such as cirrhosis) because the risks involved—although small—outweigh the benefit of any additional information from biopsy tissue.
Patients with chronic liver diseases such as Hepatitis B or C infection, fatty liver disease leading to non alcoholic steatohepatitis (NASH), or any number of other diseases leading to progressive fibrosis and ultimate cirrhosis, can be monitored by serial liver biopsies. Serial biopsies are especially important in determining response to treatments such as antiviral medications.
Liver transplant patients often undergo biopsies to detect rejection or infection. In certain cases, “protocol” serial biopsies are performed to detect recurrent disease (such as the case with transplant for Hepatitis C, which has a significant recurrence rate). Otherwise, biopsies are only performed if there are laboratory tests (liver function tests) or physical symptoms suggestive of rejection.
Bleeding is the major complication - The risk of bleeding after biopsy is low (<1%) and depends on the extent of the patient’s underlying liver disease. In patients with advanced liver disease (cirrhosis and portal hypertension), this risk of bleeding increases because the diseased liver is not making blood clotting factors properly and portal hypertension causes a low platelet count (platelets are the cells responsible for initially forming blood clots) due to an enlarged spleen, or “splenomegaly”. The risk of mortality of liver biopsy is estimated to be between 0.01% and 0.1%.
Other potential complications that are less common include: