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There are two types of liver biopsies: 1- Random liver biopsy: to evaluate diffuse liver disease such as cirrhosis.
2- Target-selected liver biopsy: to evaluate a hepatic lesion.
Random liver biopsy can be performed via transjugular or percutaneous approaches. Uncorrected coagulopathy is the only absolute contraindication for liver biopsy. Suggested thresholds by Dr. Wael E.A. Saad are:
1- For transjugular biopsy: INR =<1.7-1.9, PLT >=50,000 and aPTT =<60 s.
2- For Percutaneous biopsy: INR=<1.4-1.5, PLT >=50,000-70,000 and aPTT =< 45-50s
It is important to check for presence of ascites, evaluate liver anatomy and assess adjacent organs before procedure utilizing ultrasound.
Pre-biopsy ultrasound examination should be performed to:
1- Determine visibility,
2- Determine access,
3- Evaluate anatomy,
4- Evaluate for ascites,
5- Assess adjacent organs.
For subcapsular lesions, it is important to look for normal hepatic parenchymal segments.
After standard surgical preparation and draping, local infiltrative analgesia will be administered. Sedation can also be used. After choosing the location using ultrasound, an incision is made using an 11-blade scalpel. A coaxial access needle (17- or 19-gauge) can be passed across the hepatic capsule in the direction shown by ultrasound. Coaxial access needle can be used for multiple passes without multiple capsular punctures. It is also used for the embolization of the tract with Gelfoam or coils.
Then, an automated spring-loaded core-biopsy needle (18- or 20-gauge) passed to the end of the coaxial needle and fired. For lesion biopsies, needle should be fired outside of the lesion to include normal hepatic parenchyma. One to five cores are obtained.
.Post-biopsy ultrasound examination is for documentation and confirming the absence or presence of capsular or subcapsular hematoma. Bed rest for 1-4 hours and avoiding strenuous activity for 24-48 hours are recommended. Abdominal and/or shoulder pain is the most common complication and is seen in 37% of patients. Narcotics are usually not required. Mortality is not reported in US-guided biopsy literature. Bleeding/hypotension is reported in 1.5% of patients..
2- Target-selected liver biopsy: to evaluate a hepatic lesion.
Random liver biopsy can be performed via transjugular or percutaneous approaches. Uncorrected coagulopathy is the only absolute contraindication for liver biopsy. Suggested thresholds by Dr. Wael E.A. Saad are:
1- For transjugular biopsy: INR =<1.7-1.9, PLT >=50,000 and aPTT =<60 s.
2- For Percutaneous biopsy: INR=<1.4-1.5, PLT >=50,000-70,000 and aPTT =< 45-50s
It is important to check for presence of ascites, evaluate liver anatomy and assess adjacent organs before procedure utilizing ultrasound.
Pre-biopsy ultrasound examination should be performed to:
1- Determine visibility,
2- Determine access,
3- Evaluate anatomy,
4- Evaluate for ascites,
5- Assess adjacent organs.
For subcapsular lesions, it is important to look for normal hepatic parenchymal segments.
After standard surgical preparation and draping, local infiltrative analgesia will be administered. Sedation can also be used. After choosing the location using ultrasound, an incision is made using an 11-blade scalpel. A coaxial access needle (17- or 19-gauge) can be passed across the hepatic capsule in the direction shown by ultrasound. Coaxial access needle can be used for multiple passes without multiple capsular punctures. It is also used for the embolization of the tract with Gelfoam or coils.
Then, an automated spring-loaded core-biopsy needle (18- or 20-gauge) passed to the end of the coaxial needle and fired. For lesion biopsies, needle should be fired outside of the lesion to include normal hepatic parenchyma. One to five cores are obtained.
.Post-biopsy ultrasound examination is for documentation and confirming the absence or presence of capsular or subcapsular hematoma. Bed rest for 1-4 hours and avoiding strenuous activity for 24-48 hours are recommended. Abdominal and/or shoulder pain is the most common complication and is seen in 37% of patients. Narcotics are usually not required. Mortality is not reported in US-guided biopsy literature. Bleeding/hypotension is reported in 1.5% of patients..