Types of Liver Biopsy

A targeted liver biopsy may be required to confirm a liver cancer diagnosis. It involves taking a sample from a specific part of the body (often a mass) to examine it under the microscope for diseases such as cancer.

However, not everyone needs a liver biopsy. Often, doctors can diagnose liver cancer, specifically hepatocellular carcinoma, by reviewing the characteristics of the liver mass on imaging scans like the CT (computed tomography) or MRI (magnetic resonance imaging). They may also send various blood tests known as tumor markers (such as Alpha-Fetoprotein) to aid in the diagnosis. Your doctor may recommend a liver biopsy if the scans are unclear or more certainty is needed.

If a biopsy is needed, it can be performed in several ways.

Through the skin on the abdomen (Percutaneous liver biopsy)

A percutaneous biopsy means taking a sample of liver tissue through the skin. It is usually performed with you lying on your back with your right hand over your head.

First, the doctor will sanitize the skin area over the liver and inject some local anaesthetic. Then, they will make a small incision and carefully insert the needle through the skin. An ultrasound or CT helps guide the needle to the right place in the liver. You may be asked to hold your breath briefly to ensure the accuracy of needle placement and sample collection.

The doctor will keep the biopsy as brief as possible, minimizing the time the needle stays in the liver. Once it is done, they remove the needle and cover the area with a small dressing.

Through a vein in the neck (Transjugular liver biopsy)

A transjugular liver biopsy (TJLB) is not as common as the percutaneous liver biopsy. But it can be used when a percutaneous biopsy isn’t an option. It is useful in cases of:

• Abdominal fluid buildup
• Blood clotting issues
• Widespread liver disease, including cirrhosis and portal hypertension
• Cancer spread to the liver

Unlike percutaneous biopsy, this procedure involves taking a tissue sample from the liver through the vein in the neck. To prevent discomfort, it is usually done under sedation.

The doctor sanitises and applies some local anaesthetic to the right side of the neck. Then they insert a thin, flexible tube (catheter) into the neck vein. Under the guidance of ultrasound and live X-ray (fluoroscopy), the doctor carefully navigates the catheter from the neck vein to the vein in the liver, moving towards the tumor.

Using keyhole surgery (Laparoscopy)

The procedure is performed under sedation. The doctors make a small incision in the abdomen and insert a thin, lighted tube (laparoscope) to view the tumor site. They insert the needle along with the light tube to collect tissue and fluid samples for lab testing.

Laparoscopy requires only small incisions instead of a large surgical cut. This reduces pain, recovery time and risk of complications. After the procedure, you will have a few small incisions on your abdomen that will heal.

Surgical biopsy

A biopsy may also be done via liver surgery. When surgeons remove part of the liver containing the mass, they send the entire tissue sample to the lab for testing to learn more about the tumor. In addition to pathology evaluations, pathologists also assess the edges of the surgical sample. This is known as the surgical margin. They examine and describe the margins as:

• Negative margin (no cancer found)
• Positive margin (cancer detected)
• Indeterminate (uncertain results)

Such an evaluation helps determine if any cancer remains after surgery.

Read more: Understanding Your Liver Cancer Pathology Report