How is a liver biopsy performed?

Liver biopsy is a common way to examine the liver in real life. Generally, liver biopsy is used to check for the presence of liver disease or fatty liver. The examination is performed through puncture. Generally, the condition of the human liver can be displayed under a microscope, and some components of the human liver and liver diseases can be observed.

How is a liver biopsy performed?

Percutaneous liver puncture is based on the principle of negative pressure suction. It uses a rapid puncture method to extract a small amount of liver tissue from the liver, directly observe changes in its tissue morphology under a microscope, and then combine it with clinical data to make a diagnosis of liver disease. However, since the specimens obtained are small, it is difficult to fully represent all liver lesions. However, in cases of viral hepatitis, fatty liver, various types of cirrhosis, etc., the liver lesions are diffuse, so even though the liver tissue removed is small, it can more accurately reflect the nature and extent of the lesions. At the same time, rapid liver puncture is simple to operate. As long as the operating procedures are strictly followed, it is relatively safe and reliable, and the chance of complications is very small. Therefore, liver puncture is still a relatively valuable method for diagnosing diseases.

Liver biopsy cytology is the only way to confirm the diagnosis of fatty liver. Liver puncture is usually performed under the guidance of B-ultrasound, and liver tissue aspiration biopsy is far more accurate and safe than the previous blind liver puncture method. It has unique advantages, especially when it is difficult to distinguish focal fatty liver or chronic fatty liver with normal liver islands from liver cancer under B-ultrasound. Microscopic observation of biopsy tissue can determine the extent and type of fatty liver disease and the presence or absence of combined fatty liver hepatitis and liver fibrosis. This is also of great value for the treatment and prognosis of patients. But because it is an invasive examination. It is difficult for patients to accept and popularization is relatively difficult.

Medical knowledge

What is the medical understanding of liver biopsy?

Ultrasound-guided liver puncture biopsy is the main method for diagnosing fatty liver, especially focal biliary fatty liver. When performing morphological examination on the removed liver tissue, necessary special staining, tissue biochemical testing and special cytological examination can improve the purposefulness of diagnosis.

Two cases of focal fatty liver with metastatic liver cancer were reported abroad, with CT and ultrasound examinations indicating localized fatty infiltration. In fatty liver, the liver cells are filled with lipid droplets and the nuclei are offset. Only in gestational and tetracycline fatty liver diseases, the liver cells have tiny lipid droplets that are evenly distributed and the nuclei are located in the center. In most diseases, fat infiltration is distributed in the central area of ​​the lobule, but some are located in the peripheral area of ​​the lobule. Some are also accompanied by hepatocellular necrosis, cholestasis or fibrosis.

Main Applications

Liver biopsy is invasive and sometimes difficult for patients to accept. It is mainly used for: 1. To distinguish focal fatty liver from tumors; 2. To identify certain rare diseases, such as cholesterol ester storage disease and glycogen storage disease; 3. Asymptomatic suspected non-alcoholic fatty liver disease (NASH), liver biopsy is the only diagnostic method; 4. ALD after quitting drinking or ALD with unexplained clinical or biochemical abnormalities; 5. Obese patients who still have abnormal liver enzymes after losing 10% of their original body weight need liver biopsy to find other causes; 6. Any suspected case of not simple hepatocyte lipid degeneration or suspected multiple causes.

Related Diagnosis

Liver biopsy histological diagnosis

A complete pathological evaluation includes the type of fatty liver, the site of hepatic acinar involvement, and the pathological classification and staging of fatty liver.

Fatty liver can be divided into two types: microvesicular and macrovesicular according to the diameter of fat droplets in hepatocytes. The former may be an early or recovery manifestation of the latter, but typical microvesicular fatty liver often presents acute onset, while macrovesicular fatty liver often occurs chronically and insidiously. The distribution range of fatty degeneration of hepatocytes caused by various causes varies within the lobule, but it usually first affects the hepatic alveolar zone III. Those involving zone I have a poor prognosis.