What are the indications for liver biopsy, and what is the best way to biopsy the liver?
Liver biopsy is used for diagnosis of liver masses and of diffuse acute or chronic liver disease. The liver can be biopsied with image guidance using US, CT, or endoscopic ultrasonography (EUS) via the gastrointestinal tract. The most common imaging modality utilized for liver biopsy is US. CT is generally reserved for tissue sampling of focal hepatic lesions that are not accessible by US. Transjugular liver biopsy (TJLB), where access is obtained via the internal jugular vein and sampling is done via the hepatic veins, is an alternative to percutaneous liver biopsy in patients with diffuse liver disease, coagulopathy, morbid obesity, and ascites.
In TJLB, the risk of hemorrhage is reduced, because bleeding from the biopsy will drain into the hepatic veins. TJLB is utilized when hemodynamic evaluation is also indicated as part of the diagnostic workup or in patients who are also undergoing a transjugular intrahepatic portosystemic shunt (TIPS) procedure.