Liver Biopsy

This outpatient procedure uses a needle to obtain a small amount of liver tissue for examination by a pathologist under a microscope. Liver biopsy is the "gold standard" test in liver medicine because it allows a clinician to assess how extensive and advanced liver disease is. It also gives the clinician and pathologist the opportunity to evaluate whether liver disease might have other causes in a person whose blood work shows a hepatitis C infection. Serious risks from a liver biopsy include bleeding, infection, perforation of another organ such as the bowel, and puncture of the lung. These occur rarely, perhaps in 1 in 1,000 biopsies or less frequently.

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The role of liver biopsy in the diagnosis and management of hepatitis C is somewhat controversial. Some clinicians recommend liver biopsy routinely to all patients with hepatitis C, while others do so only selectively. At times, a patient may find biopsy helpful in deciding about whether to pursue treatment. For example, some patients may choose to defer treatment if their biopsy is near normal but pursue treatment if their biopsy shows extensive liver disease. A liver biopsy also makes it possible to look for coinfection with hepatitis B or some other condition that might be causing abnormal liver enzymes.

The liver biopsy is the best way to judge the amount of damage that hepatitis C has caused. Elevated liver enzymes indicate inflammation, but they are insensitive; about one third of patients with significant inflammation found on liver biopsy will have normal liver enzymes.