A liver biopsy is a procedure to remove and examine a small piece of liver tissue to confirm diagnoses, assess disease severity, and evaluate treatment response. It can be performed using various methods, including percutaneous and laparoscopic techniques, while careful preparation is needed to avoid complications. Indications for the procedure include chronic hepatitis, unexplained liver enzyme elevation, and suspected tumors, with follow-up required to monitor for complications.

1. Liver Biopsy
Dr. Md. Ashiqur Rahman
Resident,
Department of Gastroenterology, BSMMU

2. What is liver biopsy?
It is a procedure where small piece of liver tissue is removed and
examine to
• Confirm clinical Dx
• Asses the severity, progression
• Rx response of the disease
• First performed by German physician Paul Ehrlich in 1883.

3. Preparation
• Consent
• Absence of followings
• Ascites
• Significant extrahepatic biliary obstruction
• Encephalopathy
• Coagulopathy- PT > 4sec and PC < 60k
• Renal failure
• CCF
• Cystic lesion in liver- Hydatid cyst
• Pre-biopsy USG for anatomical abnormalities- Chilaiditi syndrome, IH GB

4. Methods
• Percutaneous blind
• Percutaneous image guided
• Transvenous-TJ
• Laparoscopic

5. What are the Needle used?
• Suction needle- Menghini, Jamshidi, Klatskin
• Cutting needle- Tru-cut, spring loaded needle

9. Procedure

10. Indications
• Drug-induced hepatitis
• Chronic hepatitis B or C
• Discordance in NIT and clinical feature
• Suspected concomitant liver disease
• Post-antiviral therapy
• Chonic cholestatic liver disease
• MRCP negative biliary obstruction
• PBC- staging and progression
• Small duct PSC

11. Continued..
• Fatty liver- steatohepatitis
• Steatosis
• Ballooning
• Lobular inflammation
• Before LT
• Occult fibrosis
• Steatosis
• Inflammation
• SOL in liver- indistinguishable from primary vs secondary

12. Continued..
• Unexplained hepatomegaly
• Unexplained liver enzyme elevation
• Storage disease

13. Special application
• Immuno-histochemical study for tumor marker
• HCC vs CC
• Early HCC vs Dysplastic nodule
• HCC vs Metastatic adenocarcinoma
• HCC- Hep-par1, pCEA, CD10, CD34
• CC- cytokeratin7,19
• Early HCC- glypican-3, HSP-70

14. Interpretations
• Specimen 2 to 3cm long and contain at least 11 portal tract.
• Finding are
• Portal inflammation
• Lobular inflammation
• Ductal reaction- ductopenia >50%
• Steatosis
• fibrosis

15. Scoring system
• Knodell
• Modified knodell/ Ishak
• Metavir
• Ludwig system- PBC

16. Ishak scoring system
Stage Findings
1 Fibrous expansion of some portal areas ± short fibrous septa.
2 Fibrous expansion of most portal areas ± short fibrous Septa
3 Fibrous expansion of most portal areas with occasional portal to portal (P-P)
bridging.
4 Fibrous expansion of portal areas with marked bridging (poral to portal (P-P)
as well as portal to central (P-C)).
5 Marked bridging (P-P and/or P-C), with occasional nodules (incomplete
cirrhosis).
6 Cirrhosis, probable or definite.

17. Follow-up after procedure
• Vitals and complains
• Every 15 mins for 2 hours
• Every 30 mins for 2 hours
• Every 60 mins for 2 hours

18. Complications
• Hemorrhage
• Hematoma
• Infection
• Capsular perforation
• Biliary peritonitis
• Pleurisy and perihepatitis
• Hemobilia
• Puncture to other organs
• A-V fistula

19. Thank You