Liver biopsy is no longer the standard test for detecting fibrosis in liver
Liver biopsy is a medical procedure helpful in detecting presence of abnormal cells in the liver.The cells develop in the liver as its response to an injury. Just like skin develops collagen to heal wounds, liver does the same way to repair the injury. What injures liver? The injury is called cirrhosis and it is never instant but developed over a time period say a decade.
The most common cause of liver fibrosis or cirrhosis is NAFLD (Non-Alcoholic Fatty Liver Disease). It is a chronic liver disease related to lifestyle. Wrong food habits, lack of exercise, fat around stomach, and lipid and sugar related problems in blood are prime causes for cirrhosis. Alcohol and Hepatitis B and C infections can also develop fibrosis. Many times, early signs are missed as the disease shows no symptoms and not could be confirmed by LFT. Here it is necessary to mention that liver function test remains normal.
By the time, the disease shows signs like jaundice and gastrointestinal bleeding, the golden time in which the disease can be controlled is lost and the patient gets little time to recover. Recover depends on factors like age and overall physical condition of the patient and prognosis. According to an estimate, more than 50% of patients die within two years after the diagnosis. It shows that liver fibrosis is diagnosed at advance stage that is when the liver becomes dysfunctional.
Liver biopsy is suggested to investigate consistent and unexplainable fever, visible mass on liver or any abnormality indicative of development of cirrhosis in liver. Some other issues for which the biopsy is conducted include:
- Issues related to digestive system
- Continuous abdominal pain
- Right upper quadrant abdominal mass
- Laboratory tests or symptoms pointing to liver as area of concern
Biopsies are conduced according to physical condition of patients. Depending on conditions doctors might advise:
- Discontinue medicines, if you’re taking meds
- Keep you empty stomach up to eight hours before the test
Hospitalization is needed for the test and the patients are given sedatives through an intravenous line. There are three ways of conducting the test.
- Percutaneous: It is called needle biopsy and it is the most common procedure of conducting the test. A very thin needle is passed to the liver to bring out a tissue.
- Transjugular: A thin needle is passed to liver through jugular vein in the neck. A small incision is made at the neck to penetrate the needle into the vein. The method is used for people with bleeding disorders.
- Laparoscopic: This method uses a tube-like instrument and sample is collected through a small incision the abdomen.
Anesthesia is used to make patients comfortable. While the first two procedures need local anesthesia, the last procedure needs general anesthesia. The incision mark is closed with stitches and properly bandaged. The mark takes two to three days in healing. The procedure takes a couple of hours to complete but the patients are allowed to leave once they gain consciousness. The sample is tested in laboratories and the process could take a few weeks.
Biopsy can detect cirrhosis at an early stage but it carries certain risks. Incision could trigger bleeding and infection and also it is painful. Cutting a tissue from liver makes it more painful. But today there is little need to do biopsy as Transient Elastography gives the similar results. TE is a non-invasive test technique to quantify liver cirrhosis. It is a simple, save and efficient alternative to invasive and painful biopsy.
TE that is also known by the brand name Fibroscan tiffness of the liver by measuring the velocity of a shear wave generated on the skin. The velocity is determined by the calculating the time the wave takes in reaching the specific part of the liver. Since fibrous tissues are harder than normal liver, the hardness is inferred by the test results. It is a simple test that takes no more than 10 minutes and the patient needs two hours fasting only. There is no waiting for results and it is a big plus as quick results save golden time.
Biopsy was the gold standard procedure to determine presence of fibrosis in liver but Fibroscan that is ultrasound elastography is now taken as standard test for confirming presence of cirrhosis. It uses a modified ultrasound probe and can be performed on approximately 95% suffering from liver disorders . Stiffness of the liver is a sign of presence of fibrosis and it can easily be measured with shear wave. The process is simple, save and affordable. The only exceptions to TE are patients that are either much older or obese.
A surgeon could recommend biopsy or TE on the results of physical examination of patients. Ultrasound elastography will be preferred, if the surgeon doesn’t find any obstruction in studying the shear waves. TE is certainly an alternative to painful biopsy.