A needle biopsy is used to take soft tissue samples. Liver laparoscopy is performed under ultrasound control and allows timely identification of organ diseases, prescribing effective treatment, determining the stage of tumor development and the degree of maturity of metastases.

What is a puncture: contraindications

Puncture (from Latin punctio - injection) is a manipulation, the essence of which is to puncture tissue, the wall of a vessel, a hollow organ or a pathological formation with a needle or a special surgical instrument (trocar) for diagnostic or therapeutic purposes. If during the procedure the patient is injected with blood substitutes, medicinal substances into the tissues, the pathological focus, excess fluid is removed, and local anesthesia is given, then it is considered not diagnostic, but therapeutic. Using the first one determine:

• the presence of purulent leakage, data are obtained for choosing a treatment method, the opportunity to conduct a bacteriological study;
• organ functions;
• volume of circulating blood or its components;
• pressure in blood vessels, cavities of the heart, skull.

• makes it possible to introduce radiopaque substances, gas, special preparations into a vessel, bone, cavity in order to identify a tumor, inflammatory processes, their localization in soft tissues, as well as extract pus, blood, etc.;
• ensures the introduction of optical instruments into the cavity for examining organs (for example, thoracoscopy - examination of the pleural cavity with a special instrument through a puncture in the chest), identifying a tumor;
• allows nutrients to be administered by intravenous infusion (that is, bypassing the gastrointestinal tract).

Ultrasound-guided liver puncture

A liver biopsy is prescribed to confirm, change the clinical diagnosis, determine the activity, severity and form of tumor damage to the organ, diagnose systemic diseases, and evaluate the treatment. It also helps to identify metabolic disorders, the cause of changes in liver tests, fever of unknown origin, etc. A puncture is always prescribed if its diagnostic value is higher than the possible risks.

The following are considered absolute contraindications to the procedure:

• patient refusal;
• lack of safe access to the liver (acoustic window), this pathology is very rare;
• unconsciousness, mental illness, when it is impossible to obtain the patient’s consent.

Among the relative ones, the following are distinguished: poor blood clotting, accumulation of fluid in the abdominal cavity (ascites), diseases that are accompanied by impaired permeability of the vascular walls (varicose veins, hypertension, atherosclerosis). Also included in this category are allergic reactions to anesthetics, purulent-inflammatory diseases of the organ, and biliary cirrhosis of the liver.

The procedure must be carried out in compliance with the rules of asepsis and antisepsis in a procedure room by the attending physician or a specialist of a certain profile (with the exception of taking blood from a vein or administering medications through it).

Specifics of the procedure

During a liver puncture, the doctor takes a piece of organ tissue for examination in the laboratory. Before starting the procedure, the patient is in a lying position.

The specialist cleans and numbs the desired area. He then makes a cut in the skin a few millimeters in size and uses a special syringe to remove a piece of tissue. To do this, use a trephine needle with a diameter of 16 G (1.6 mm), a length of 150–200 mm with a cutting mechanism for taking material. During the manipulation, the doctor asks the patient to follow some instructions, for example, breathe or not breathe, turn around. After taking a liver sample, a sterile patch is fixed to the skin. On average, the procedure lasts minutes.

Advice: on the day of the biopsy, you should not take a hot shower or bath, and for several days after it you should not lift heavy objects.

It is often performed even if a tumor is detected, but always under ultrasound control. It is important to choose an experienced doctor who can determine a safe acoustic window for puncture. Liver resection (removal of part of an organ along with the affected area) can only be performed if the tumor is small and the organ is functioning normally, in order to avoid the development of liver failure.

Mandatory condition: at the end of the procedure you need to lie down for 4-6 hours. The patient spends this time in the hospital, ice is placed on the wound area for pain relief. For some time (up to 2 days), when you inhale, you may feel pain in the right side, shoulder, back, and sometimes blood appears in the urine.

Preparing for a liver biopsy

Before the puncture, it is necessary to undergo tests

Before taking a puncture, the doctor prescribes blood tests (in particular, coagulation level, group, Rh factor). An important point is to control the intake of medications that can cause erroneous results or slow down clotting: aspirin, warfarin, ibuprofen. A week before the procedure, you should stop taking them. If the patient is allergic to anesthetics, it is necessary to tell the specialist about this.

Drugs for the treatment of the liver after removal of the gallbladder (cholecystectomy) will help reduce the stagnation of bile (cholestasis syndrome) in the ducts of the organ by taking choleretic agents, enzymes, and hepatoprotectors. Removal of stones from the gallbladder can be done using closed cavity surgery or non-surgically: dissolution with medications, laser, ultrasonic waves, chemicals, for example, methyl tert-butyl ether. The intervention is carried out using several technologies, depending on the patient’s condition, the duration of the disease, and the severity of the inflammatory process.

Advice: if after taking samples the patient feels dizzy or severe pain, this should be reported to the doctor or nurse immediately. In this case, doctors must check blood pressure, monitor the condition and, if necessary, give painkillers and take tests.

Risks and complications

The use of modern technologies during the procedure under continuous ultrasound control virtually eliminates the occurrence of complications. But you need to be aware of all the risks. After manipulation, inflammation of the wound, bleeding (including internal bleeding), bile peritonitis may develop, there is a possibility of damage to neighboring organs, and trauma to large vessels.

To prevent the occurrence and development of complications, the procedure must be done in a hospital setting with a qualified specialist. It is important to insist on control ultrasound examinations of the intervention area using Doppler examination methods (they are carried out using special new generation ultrasound devices).

Liver biopsy is one of the most effective, informative methods for diagnosing many diseases, assessing the development of tumors, and the effectiveness of treatment. Carrying out the procedure under continuous ultrasound control makes it as safe as possible, significantly reduces the list of contraindications and improves the quality of the sample taken.

Liver puncture for metastases

The article is for informational purposes only. Specialist consultation is required.

Liver metastases: symptoms and prognosis

Liver metastases are a secondary type of cancer. They occur when a malignant tumor affects the intestinal tract, lungs, mammary glands, prostate gland and other organs. Symptoms of liver metastases are identical to those of liver cancer.

Facts about liver metastases

1. Dangerous metastases in the liver exceed 10 centimeters in size.

2. Metastases provoke the occurrence of liver failure, as well as severe intoxication of the body due to the fact that the liver ceases to perform its functions.

3. Most often, the occurrence of metastases in the liver is provoked by malignant intestinal tumors.

4. Liver metastases are found in 1/3 of all people suffering from cancer.

5. Liver metastases occur least often in patients with prostate and ovarian cancer.

Signs of liver metastases may be as follows:

Severe non-conductive fatigue;

Problems with stool;

Pressing pain appearing in the area of ​​the right hypochondrium. It becomes stronger as the malignant tumor grows;

Yellowing of the mucous membranes and skin;

Increase in body temperature to 39 degrees Celsius.

Due to the fact that the symptoms of metastases in the liver are very similar to the signs of diseases such as cholangitis, cholelithiasis, cholecystitis, metastases are detected quite late. The prognosis in this case is extremely unfavorable.

Diagnosis of liver metastases

To diagnose liver metastases, the doctor prescribes the patient to undergo a large number of studies:

Ultrasound of the abdominal cavity. Thanks to this study, single as well as multiple metastases in the liver and their size are determined;

SCT or NMRI. Diagnostics in this case is highly accurate;

Blood test from a vein and from a finger.

The method of treatment depends on the number of tumor foci and the type of cancer. For the treatment of liver metastases the following is used:

Chemotherapy. With its help, it is possible to make tumors smaller in size and prolong the patient’s life for some time;

Radiation therapy. Its main function is not to reduce the size of tumors, but to relieve pain;

Surgical treatment. It is resorted to only if the metastases are single;

Liver resection. It is carried out both for single and multiple metastases;

Percutaneous transhepatic radiofrequency ablation.

The prognosis for patients with liver metastases is as follows:

1. If there is one malignant node in the liver, 52% of patients survive over the next five years after the prescribed treatment.

2. With two nodes in the liver, only 38% of patients survive.

3. Multiple malignant nodes in the liver leave only 18% of patients with a chance of survival.

Metastases in the liver. What is the life expectancy?

It is quite difficult to predict the lifespan of people with liver damage. Metastases grow very quickly and can cause stage 4 liver cancer.

This disease can significantly shorten the patient’s life (usually he has no more than six months to live).

Secondary neoplasms can penetrate the liver from the esophagus, lungs, stomach and intestines. Since the liver's job is to cleanse the body of toxins, quite a lot of blood passes through it, which may contain cancer cells. The patient loses weight, his performance decreases, and nausea and vomiting begin.

When the liver is affected by metastases, it increases in size. Because of this, the functioning of other organs is disrupted. Fluid exchange in the body is disrupted and ascites develops, which further complicates the ability to predict the patient’s life.

Metastases in the liver

Metastases are malignant secondary neoplasms. They can occur in any organ, disrupting the proper functioning of the body. Metastases are capable of releasing toxins that interfere with the functioning of the internal system. They can destroy tissue and poison the body.

Quite often, metastases occur in the liver. Metastases develop rapidly and in a very short period of time can disrupt the functioning of an organ. They can affect either one or many areas of the liver. It is quite difficult to predict the life span of a patient with metastases that have affected the liver. If metastases provoked the fourth stage of liver cancer, then this, unfortunately, is an irreversible process of proliferation of cancer foci throughout the body.

Experts do not consider the mere presence of metastases in the liver to be a death sentence, and it is impossible to answer exactly how long people with this pathology live. There can be a wide variety of cases of disease development. Among patients, two main groups can be distinguished, depending on secondary neoplasms:

• with single lesions;
• with three or more cancerous nodes on the organ.

The life expectancy of a person after a diagnosis of cancer depends on how the metastases behave. If they are highly active, the patient will live from one to three months. And if there is only one secondary tumor in the liver, which is sluggishly growing or has stopped growing, it is possible to prolong life up to six months.

Symptoms of liver cancer with metastases

Favorable prognosis and survival rate increase with timely treatment and detection of the disease. Many symptoms can indicate the presence of metastases. But they are all nonspecific and similar to the symptoms of other pathologies.

Reasons for performing liver examinations and tests may include:

• sudden weight loss leading to exhaustion;
• dull pain and feeling of heaviness in the right hypochondrium;
• severe weakness and fatigue;
• increased heart rate;
• increased body temperature;
• liver enlargement;
• nausea and vomiting, yellowness of the skin and sclera of the eyes;
• discoloration of stool and darkening of urine;
• expansion of the saphenous veins in the abdominal area;
• enlargement of the mammary glands.

Also a common sign of the development of liver metastases is pain when the portal or inferior vena cava is compressed. Often, pain symptoms take the form of various pathologies, for example, if the lesion is localized under the dome of the diaphragm, the patient complains of pain when breathing. This symptomatology is similar to pleurisy. And with non-single lesions it is even more difficult to make a correct diagnosis.

Complications and risks

If liver metastases are diagnosed at an early stage, the patient’s life expectancy increases. And if specialists have eliminated the primary and secondary malignant tumors, then there is a chance to live for several more years if there are no relapses. But, unfortunately, this happens quite rarely. When doctors detect metastases in the liver, they often do not give the most favorable prognosis for life expectancy and cannot say unambiguously how long the patient will live.

There are a number of methods that help prolong the patient's life:

• chemotherapy;
• irradiation of metastases using radioactive elements;
• diet;
• surgical intervention.

Doctors can slow the growth of metastases slightly with chemotherapy. It helps destroy small tumors, but the method itself can give many side effects that can greatly affect human health.

Radiation therapy can reduce the size of tumors. This technique has the power to deliver targeted strikes to affected areas and eliminate problems using radioactive isotopes.

Surgical intervention increases the patient’s life expectancy extremely rarely. Typically, all of the above methods are used in combination.

The patient is prescribed a diet that must be strictly followed. You need to give up alcoholic and carbonated drinks, canned food, and various smoked foods. Eating fatty meats and foods with artificial additives is also prohibited. The patient’s lifespan depends on the diet; it can even extend it by 30%.

In some cases, it is possible to prolong the patient’s life using folk remedies. But it is very important to use them only after the attending physician approves such a technique. In many cases, celandine is used, because it can inhibit the development of cancer cells.

Treatment effect

How long do people live with liver metastases? If the liver is affected by secondary malignant formations from the stomach, pancreas, lungs and other organs, it is necessary to apply treatment in the complex described above.

Because surgery alone will not give a positive effect.

A good result can be obtained if the patient has cancerous nodules that have penetrated into the liver organ from the colon. In this case, the patient can live more than three years after treatment.

If the tumor was detected at the first stage, and specialists carried out the correct treatment, then according to statistics, about 50% of such patients live more than five years. But this only happens if there is only one metastasis in the organ.

If there are two cancerous nodes in the liver structures, then the survival rate of patients over five years is approximately 40%. If there are three or more metastases, the number of patients with a five-year survival rate decreases to 20%.

The survival period of people with severe damage to liver structures after complex therapy ranges from six months to one and a half years. The longest survival period may be if the metastases have penetrated the hepatic structures of their rectum - about two to three years.

Damage to the liver by cancerous nodules is a very serious blow to the patient’s health, which can significantly shorten his life. And life expectancy is determined by the specifics of tumor development.

Liver parenchyma biopsy: purpose, types, prices

One of the first roles in the life of the body, especially in the field of digestion and excretion, is played by the liver.

It is large in size and weighs approximately two kilograms. The complex structure of its parenchyma consists of cells (lobules), blood and lymphatic vessels, the gallbladder and ducts through which the produced bile moves.

The physiological mechanism of liver functioning can be disrupted due to negative environmental factors or concomitant pathological conditions, both the liver itself and other organs and systems of the body.

To identify the causes of liver dysfunction, a set of diagnostic measures has been developed and widely used in medical practice.

Diagnostic methods for studying the liver

• Hepatest. Clarification of the clinical picture by taking an anamnesis: general condition; hereditary predisposition; presence of subcostal pain; color of skin, feces, urine, etc.);
• Blood and urine examinations. Collection of general and biochemical analysis;
• Examination using ultrasound. Detection of stones in the gall bladder and expansion of bile channels in the liver, tumor processes, determination of the density, boundaries and size of the organ and its circulatory system;
• X-ray examination. Angiographic method of introducing a contrast agent into the hepatic ducts;
• Gland biopsy. Excision of an area of ​​parenchymal tissue or blood of the inferior vena cava.

To establish a final diagnosis and prescribe the correct treatment for liver diseases, the results of collecting anamnesis, clinical symptoms and a superficial examination are not always enough.

To identify deep structural tissue disorders, the liver puncture method is used.

Indications for gland puncture

Expansion of the borders and increase in liver volume for an unknown reason;

This type of diagnosis is prescribed in hospitals, medical centers, hospitals and dispensaries equipped with special equipment.

The procedure should be carried out under the supervision of experienced and qualified medical professionals: certified radiologists, surgeons, nurses and ultrasound doctors.

Conducting a survey

• A referral for a biopsy is issued by the treating hepatologist, therapist or resuscitator;

Instructing the patient before undergoing gland puncture: a week before the procedure, stop taking coagulants (blood thinners);

Avoid drinking and eating 10 hours before the puncture.

Blood sampling (general analysis);

In this practice, well-tolerated liver biopsy methods are also used:

1. Transvenous sampling of material. It is carried out by aspiration of tissue through the right jugular, inferior vena cava into the parenchyma of the gland using ultrasound. It is used in cases of bleeding tendency and in cases of severe ascid in the patient.
2. Laparoscopic diagnostic method. To study a subject fragment of parenchyma, the material is excised by introducing a video tube into the organ through an opening in the abdominal cavity.

Contraindications

When liver puncture is indicated, it is very important to exclude possible negative consequences of this diagnostic method.

Important! It is necessary to take into account the pathology clinic, anamnesis of previous diseases and the results of the tests performed.

The procedure is not prescribed:

• With increased blood coagulation (low clotting);
• For obesity;
• For anemia;
• With peritonitis;
• In advanced cases of cirrhosis, alcoholic and oncological hepatitis.

Biopsy studies are considered a minor operation and therefore it is necessary to take into account possible complications after an intercostal puncture of the liver:

Minor inflammatory processes of the pleural layers (Pleurisy);

Development of bleeding (with reduced coagulation, bleeding begins from the parenchyma of the gland, filling the peritoneal area or when nearby vessels are punctured, during perforation of the intercostal artery, inside the chest).

Excessive bleeding can be fatal if angiographic embolization, pleural drainage, and blood transfusion are not performed;

List of services for puncture:

Collection of urine and blood tests (general and biochemical) and additional diagnostics before biopsy;

Puncture kit

Addresses and prices for diagnostics using hepabiopsy:

Medical center K+31

Moscow st. Lobachevskogo, 42, bldg. 4 tel:

Medical center KB MEDSI

Moscow st. 2nd Botkinsky Prospect, 5 bldg. 3 and 4. Tel:

Endosurgery and Lithotripsy Center

Moscow, Entuziastov Highway, 62 tel:

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Liver metastases prognosis

Metastases in the liver

Cancer is the plague of the 21st century, the number of patients around the world is growing every year. According to statistics from the International Agency for Research on Cancer, in 2012, about 10 million patients with cancer were registered, and by 2025 this figure will be about 20 million. In Russia, there are almost 500 thousand people with a malignant tumor. Of these, more than 100 thousand have liver metastases. Metastases are secondary lesions that form from the main tumor and travel through lymphatic or blood vessels to other organs, forming new formations.

Why liver?

The most common location of metastases is the liver. The reason for this is the peculiarity of blood circulation in this organ. Detoxification is its main function, which involves cleaning out toxins that enter the body. Therefore, about 1.5 liters of blood passes through the liver per minute, not only through the arteries, but also through the portal vein. Such active blood circulation in the organ creates a favorable environment for the formation of new tumors. Most often, metastases affecting the liver are typical for patients with primary tumors of the lungs, stomach, pancreas, colon, and breast. Less commonly, the liver suffers in cancer of the kidneys, ovaries, prostate and esophagus.

Stages of metastasis development

There are three stages of their development in the organ:

• Grade 1, single metastases - the liver is affected in less than 25% of the entire area, one focus of a new tumor has arisen.
• 2nd degree, multiple metastases in the liver are bilobar multiple foci (more than three) with a volume of up to 25% or one, single foci, but with a volume of more than 25%.
• 3rd degree, multiple metastases - damage to multiple foci. The most complex form, in which more than 50% of the entire organ area can be affected.

What are the symptoms of the disease?

• Sudden weight loss;
• loss of appetite, up to anorexia;
• tachycardia, fever, high temperature;
• pain under the rib, which intensifies as the tumor grows;
• yellowing and itching of the skin and mucous membranes are observed;
• intestinal dysfunction;
• severe weakness, up to loss of consciousness.

Diagnosis of the disease

In order to correctly establish the diagnosis and identify metastases in the liver, the doctor prescribes certain medical examinations.

• Nuclear MRI or SCT, studies using these methods, are highly accurate in determining the presence of metastases.
• Ultrasound of internal organs, in particular the abdominal cavity. The procedure will help determine what form the metastases have - single or multiple.
• MRI, angiography, allows you to determine the exact size of tumors, their location, invasion into neighboring organs, suppuration
• Biopsy - if necessary, determine the type and degree of maturity of metastases and their decay.
• Blood test;
• urine test;
• puncture.

Treatment of cancer with metastases

Definitely, the presence of metastases in the liver complicates the treatment process and the prognosis of the future life of a patient with a secondary form of cancer, doctors try not to do this. Directly, treatment and life expectancy depend on the degree of neglect of the disease, which is determined after diagnosis.

The first thing any treatment begins with is a strict diet. Cigarettes and alcoholic beverages, fatty and fried foods, carbonated drinks should be completely excluded, since the organ cannot fully function and the liver simply cannot bear the additional load in the fight against excess toxins.

Liver cancer treatment

Having determined whether the patient is operable, liver resection is prescribed. Before the operation, the organ is prepared for intervention. Initially, single foci are removed and only then, using resection, the main part of the cancer cells is removed. This procedure makes sense when the prognosis after the operation should be satisfactory and the liver should maintain its functionality, continuing its work, saving the patient’s life. Resection is possible only if the metastases occupy no more than 50% of the entire liver area.

Unfortunately, in most cases, surgical intervention is not possible; according to statistics, only 20% of patients are operable. Then, doctors prescribe radiation or chemotherapy. These methods can improve the patient’s quality of life, but cannot get rid of metastases; they only slow down the process of liver necrosis and reduce pain.

With the help of chemotherapy, the necessary cytostatic drugs are injected through a catheter directly into the affected organ. The method allows you to stop tumor growth and in some cases even destroy small tumors, but it has many contraindications.

The best effect was seen with complex treatment with the addition of restorative therapy.

Radiation therapy can also stop the growth and even reduce the size of an existing tumor. Modern technologies make it possible to place radioactive substances in the middle of the tumor, thereby not causing harm to healthy tissue.

Prognosis for treatment of liver metastases

If the metastases are single and detected at an early stage, when all functions of the liver are still preserved, the prognosis after surgery is more favorable. With multiple metastases, the picture is not so positive. Treatment can prolong and improve the patient’s quality of life and completely eliminate the disease, which modern medicine, unfortunately, cannot do. The best effect is provided by organ resection (if the method is possible), but in cases where cancer metastasis occurred only in the liver and did not affect other organs.

Danger of metastases

The main danger posed by primary or secondary cancer in the liver is compression of the vena cava or bile ducts. They are characterized by a significant increase in bilirubin in the blood. It is toxic to the body and can lead to death. In addition, elevated bilirubin does not make it possible to use radiation or chemotherapy, as well as surgery. Urgently, in case of hyperbilirubin, a drainage system is prescribed, which allows the outflow of bile from the liver to be restored.

It is possible to prevent the occurrence of metastases in the liver only with early diagnosis of the main primary focus of the disease and its timely treatment. Therefore, be vigilant, monitor your health and listen to your body. Don't let the disease overcome you. Be healthy!

For the first time, your doctor has given you a referral for a liver biopsy, explaining that this is necessary to clarify the diagnosis. A number of questions immediately arise: is this procedure dangerous, is it painful, how is it performed, and does it have any consequences? This is exactly what we will talk about. But it should immediately be noted that such manipulations are performed only by qualified specialists using modern medical equipment, and therefore there is no cause for concern.

What is a liver biopsy

In medicine, biopsy is used very widely and in almost any organ and area of ​​the body. The term itself comes from the Greek bio - living and opsis - to examine, study, that is, literally translated, it means to examine living tissue. To do this, they take a small sample of it and send it to the laboratory, where it is subjected to a comprehensive analysis - examination under a microscope to identify viruses, bacteria, and malignant cells. They also conduct all kinds of modern research - spectrographic, molecular genetic.

The liver is subjected to such examination quite often, because it is susceptible to many diseases - inflammatory, viral, the development of various tumors, and is a favorite place for metastases to settle in cancer of other organs. For example, it largely depends on whether there are metastases in the liver and other organs. All this pathology cannot always be accurately recognized using ultrasound or tomographic diagnostic methods. Examination of a liver tissue sample always “sheds light” in doubtful cases and allows you to make the right choice of treatment tactics.

Indications

As a rule, taking a sample of liver tissue is done after a preliminary ultrasound or tomographic scan (CT, MRI, PET), when it is necessary to clarify the nature of the identified disease, in the following cases:

• in case of deviations in biochemical tests of the liver, violation of its enzymatic function;
• if there is a suspicion of cancer;
• for cancer of other organs and suspected liver metastases;
• in case of liver enlargement (hepatomegaly) of unknown nature;
• when jaundice appears, the cause of which has not been established by other methods;
• for hepatitis to determine its nature and cause;
• with congenital liver anomalies, congenital enzymopathies;
• when there is cirrhotic liver damage - to determine the cause of cirrhosis (it is alcoholic or after hepatitis, or biliary, associated with a violation of the outflow of bile);
• when complications arise after a kidney transplant operation;
• in cases where orthotopic is performed - before and after;
• when unexpected things develop.

All these indications are determined after a thorough examination of the patient by a council of doctors - hepatologist, infectious disease specialist, oncologist.

Preparation for the procedure

Most often, this study is performed on patients undergoing inpatient treatment, where the medical staff themselves will provide appropriate training. In cases where the patient is undergoing an outpatient examination and is given a referral for a biopsy, he must prepare for it in advance:

• a week before the procedure, stop taking medications that reduce blood clotting, including aspirin, ibuprofen, paracetamol, diclofenac, to avoid bleeding;
• undergo the examination prescribed by the doctor on time and pass all the necessary tests;
• the last meal and liquid should be no later than 8 hours before the scheduled procedure;
• If you are constantly taking medications, you do not need to stop taking them, but simply take them with just one sip of water.

Types of biopsy and technology

Several types of biopsy are used, the main ones being:

• liver puncture biopsy;
• incisional or intraoperative;
• laparoscopic;
• transvenous.

Liver biopsy

This method is most often used for hepatitis, it is the least traumatic and can be performed on an outpatient basis, without hospitalization of the patient. The technology is as follows. The patient lies on his back, a special transparent gel for the ultrasound sensor is applied to the skin of the abdomen, an ultrasound scan of the liver is performed and the desired area to be punctured is determined. Next, the skin is treated with an antiseptic and an anesthetic is injected. It is necessary to breathe correctly during the manipulation, as instructed by the doctor.

After the onset of anesthesia, a puncture is performed with a special needle under the control of an ultrasound sensor, which resembles a microphone, which is located next to the puncture site, and a tissue sample is taken under the control of the image on the screen of the ultrasound machine.

The outer end of the needle is connected through a tube to an aspirator, or a special pneumatic “gun” is used to suck a sample of liver tissue into the lumen of the needle. Next, the needle is removed and the injection site is covered with a sterile bandage.

Incisional biopsy

This sampling method is always performed during surgery, for example when a metastatic node or tumor is removed. The removed lesion or section of liver tissue is sent to the laboratory for examination. If urgent analysis is needed to determine further tactics, surgeons cover the wound and wait for an answer from the laboratory. This usually happens with cancer or its metastases.

Laparoscopic biopsy

This method is performed during a laparoscopic diagnostic examination of the abdominal cavity or during laparoscopic surgery. A fiberoptic probe with a video camera and lighting, and special surgical instruments are inserted through small incisions in the skin of the abdomen. Based on the image transmitted by the camera to the screen, a sample of liver tissue is taken using special forceps or a loop, and hemostasis is performed (cauterization of blood vessels).

Transvenous biopsy

The method is used in cases where entry into the abdominal cavity is very undesirable, for example, when there is fluid in it, or when blood clotting is reduced and the likelihood of bleeding is high during the puncture or laparoscopic method. In this case, after anesthesia, an incision is made in the patient's neck, and a long vascular catheter is inserted into the jugular vein. Under the control of an X-ray machine, it is gradually moved down the inferior vena cava until the hepatic veins enter it, a catheter is entered into them, and a tissue sample is taken using a special needle at the end.

After diagnosis

Only the puncture method is done on an outpatient basis, the rest require hospitalization of the patient, when he is monitored by medical personnel. At the end of the outpatient procedure, the patient is under the supervision of a doctor for 3-4 hours; this can be a one-day hospital stay. After this time, the doctor re-examines the patient, measures blood pressure, and, if necessary, conducts an ultrasound examination.

If everything went well, there is no severe pain or signs of bleeding, the patient is sent home. As for the pain, it is not as severe as, for example, and goes away quickly with the help of painkillers.

Advice: During the first 24 hours, driving is not recommended, and in the next week you should refrain from physical activity, thermal procedures and taking anti-inflammatory drugs that reduce blood clotting (aspirin and the like).

Liver biopsy is a necessary diagnostic procedure that should not be avoided. It is always performed in the interests of the patient’s health, has strict indications and plays a decisive role in the differential diagnosis of various liver diseases.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Biopsy is a test that is widely used in medicine. This term itself comes from the Greek words “bio” - living and “opsis” - to study. In other words, a biopsy is a comprehensive study of a small fragment of living tissue, during which a variety of pathologies can be identified.

The liver is often the target of biopsy because this organ is vulnerable to various inflammatory and viral diseases. In addition, it is in the liver that metastases often appear in cancer of other organs. It is not always possible to recognize pathology using ultrasound or tomography, but examining a tissue sample obtained as a result of a biopsy helps to “shed light” on the essence of the disease, determine its etiology and choose the right treatment method.

Some patients who are not well-versed in liver biopsy are intimidated by the procedure. However, there is no need to fear that removing a fragment of liver tissue will negatively affect the health of the organ. The liver recovers very quickly after any manipulation. In addition, during a biopsy, 1/50,000 of the organ is removed. This is a negligible amount, and therefore the procedure will not have any negative consequences for the patient’s condition.

Indications for the procedure

You cannot “prescribe” a liver biopsy for yourself. The decision on the need for this type of diagnosis is usually made by a council, which, in addition to the attending physician, includes a hepatologist and an infectious disease specialist.

As a rule, a conclusion about the need for a biopsy is made after an ultrasound or tomographic examination is performed, but the data obtained is not enough to clarify the etiology of the detected disease.

The reason for prescribing a biopsy may be serious deviations in biochemical analysis, as well as liver enlargement, the nature of which cannot be determined. This diagnosis is carried out if the presence of a malignant tumor is suspected, as well as when oncology of other organs and the possibility of metastases to the liver are detected. Also, indications for a biopsy are hepatitis, congenital liver abnormalities, and cirrhotic phenomena. Finally, liver biopsies are performed before and after orthotopic liver transplant surgery.

Before making a final decision to perform a liver biopsy, the patient must undergo a clinical blood test, a coagulogram, tests for HIV and syphilis, as well as a test to determine the blood type and Rh factor. An ECG is also performed. All these studies help to identify possible contraindications for biopsy and choose the most appropriate procedure method in each specific case.

Types of liver biopsy

As noted above, there are several types of liver biopsy. There are separate indications and contraindications for each of them.

The following types of biopsies are currently performed:

1. Percutaneous puncture biopsy of the liver.
2. Fine needle aspiration biopsy under ultrasound or CT guidance.
3. Transjugular (transvenous) biopsy.
4. Laparoscopic biopsy.
5. Incisional biopsy.

Percutaneous needle biopsy of the liver

This type of biopsy is most often used to diagnose patients suffering from hepatitis. It is considered the least traumatic, and therefore this procedure is usually performed in an outpatient setting, without hospitalizing patients. It only takes a few minutes.

The procedure is carried out as follows. The patient is asked to lie on his back so that the body is slightly tilted to the left. The right hand must be placed behind the head. The puncture site is treated with an antiseptic and local anesthesia is administered. After this, a puncture is performed. To prevent other tissues from getting into the lumen of the needle, a sterile saline solution is drawn into the syringe. To make the needle pass easier, the skin is first pierced with a special stylet or a tiny incision is made with a scalpel. While advancing the needle, the doctor gradually pumps saline solution from it.

In order to take a sample of liver tissue, the doctor asks the patient to hold his breath and withdraw the syringe plunger all the way. The collection of material itself lasts literally a few seconds. After this, the needle is removed, and the puncture site is treated with an antiseptic and a bandage is applied to it. Two hours after the procedure, the patient undergoes an ultrasound of the abdominal organs to exclude the presence of fluid in the puncture area.

As a rule, it is PSBP that is performed for hepatitis, cirrhosis, and also in order to find out the causes of liver enlargement. In addition, this procedure is used to monitor the patient's condition after transplantation.

Contraindications for diagnosis are a history of unexplained bleeding, low blood clotting, and the presence of a hemangioma or hydatid cyst in the liver. The procedure is not recommended for patients with severe obesity, as well as those who have been diagnosed with hemophilia.

It is also worth mentioning the possible complications that the procedure may cause. Despite the fact that PSBP is considered a relatively safe procedure, provided that the doctor has the appropriate experience and qualifications, the possibility of unpleasant consequences cannot be completely ruled out. Thus, in 0.2% of cases, bleeding occurs, which is caused by perforation of the branches of the portal vein.

Approximately a third of patients complain of pain after the procedure. Pain sensations occur in the right upper quadrant of the abdomen and can radiate to the epigastrium and right shoulder. As a rule, the pain goes away after the administration of analgesics within one to two weeks.

The most serious complication is considered to be perforation of the colon, which is instantly recognized by the contents of the syringe after a biopsy.

Fine needle aspiration BP (FNA) under ultrasound or CT control

This type of biopsy is used to obtain material for cytological examination if a malignant tumor is suspected. In addition, this study is carried out if the patient has been diagnosed with vascular or echinococcal liver lesions.

To carry out the procedure, the patient is asked to lie on his back or left side. The puncture site is treated with an antiseptic and local anesthesia is administered. Using ultrasound or CT data, the puncture trajectory is outlined, after which a pinpoint incision is made with a scalpel. The needle is inserted under ultrasound guidance. When it reaches the required area, a syringe is connected to the needle and tissue is collected. After this, the needle is removed, the puncture site is treated with an antiseptic and a bandage is applied. Before transporting the patient to the ward, a repeat ultrasound is performed.

Transjugular (transvenous) biopsy

This research method is usually used when a patient is diagnosed with ascites. This method is also recommended for reduced blood clotting - in this case, puncture or laparoscopic biopsy methods are fraught with the development of bleeding. Also indications for choosing this particular research method are obesity and vascular tumors.

Typically, the procedure takes from half an hour to an hour. The patient is asked to lie supine and electrocardiographic monitoring is performed. After treating the neck area with an antiseptic, local anesthesia is administered. The next step is to make a small incision over the jugular vein and insert a vascular catheter into it. The catheter moves to the liver under the control of X-ray equipment. When it passes through the right atrium, there is a risk of developing arrhythmia. Next, the catheter moves along the inferior vena cava to the right hepatic vein. When it reaches the required point, a special needle is inserted into the catheter and a biopsy is performed. At this point, many patients complain of pain in the right shoulder or under the ribs. After the material is obtained, the catheter is removed from the jugular vein, the wound is treated with an antiseptic and a bandage is applied. After this, the patient is transported to the ward.

Contraindications for this procedure are bacterial cholangitis, the presence of cystic liver lesions, and thrombosis of the hepatic veins.

If we talk about possible complications of transvenous biopsy, then in the case of perforation of the liver capsule, massive intraperitoneal bleeding may develop.

In addition, in very rare cases, pneumothorax and dysphonia may develop.

Laparoscopic biopsy

Laparoscopic biopsy can be performed during general laparoscopic diagnosis or laparoscopic surgery. This diagnosis is carried out under general anesthesia. The doctor makes small incisions in the skin of the abdomen, through which a lighted fiberoptic probe with a video camera and special surgical instruments are inserted into the abdominal cavity. The camera transmits an image to the screen, based on which a tissue sample is taken using special forceps or a loop. After the biopsy, the tissue is cauterized to stop bleeding. After removing the instruments and laparoscope, the wounds are treated and bandaged.

This type of diagnosis is carried out in order to determine the stage of tumor growth in case of peritoneal infection.

This procedure is not recommended for severe cardiac and respiratory failure, peritonitis of bacterial origin, or in case of intestinal obstruction. The procedure is complicated by severe obesity, as well as by a hernia of the abdominal wall.

Possible complications of laparoscopic biopsy can be quite serious and include ruptured spleen, severe pain and hematoma of the anterior abdominal wall.

Incisional liver biopsy

During surgery, an incisional biopsy may be performed. The organ tissue is excised and sent to the laboratory. In the event that a test result is needed before completion of surgery, the operation is suspended until an answer is received.

Preparation for the procedure

In order to avoid complications during liver biopsy, you should be properly prepared for the procedure. Usually the doctor instructs the patient on what measures need to be taken.

First of all, it is recommended to stop taking non-steroidal anti-inflammatory drugs a week before the procedure. If you are taking anticoagulants, you should definitely notify your doctor about this.

Three days before diagnosis, you need to review your diet. Products that can cause flatulence should be excluded. This is black bread, raw vegetables and fruits. It is also recommended to take medications that prevent gas formation.

On the eve of the procedure, you must eat your last meal no later than 21:00. Dinner should be very light. On the day of the procedure, a general blood test and control ultrasound are performed. Liver biopsy is performed exclusively in the morning, on an empty stomach.

How to behave after the procedure

Doctors recommend bed rest for 24 hours after any type of biopsy. You should lie on your right side for at least two hours after the procedure. An ice pack may be placed on the biopsy site. Every two hours, patients have their blood pressure measured and their heart rate monitored. Eating is allowed no earlier than three hours after medical procedures.

As a rule, within a day after performing those types of biopsies that are considered minimally invasive, patients are discharged from the hospital. Doctors recommend refraining from physical activity for at least two days after the procedure. For a week after the biopsy, you should stop taking medications containing Aspirin, as well as anti-inflammatory drugs. In addition, thermal procedures are not permitted.

A liver biopsy is a diagnostic procedure in which biomaterial is taken from the liver for histological and research.
This diagnostic procedure is considered quite complex and is carried out only if there are a number of indications.

Consequences

The safety of a liver biopsy depends on the skill of the person performing it. Most often, liver biopsy is accompanied by complications such as:

1. Pain syndrome. This is the most common complication encountered after taking a biopsy. Usually the pain is dull, not intense, and goes away in about a week. If the discomfort is pronounced, then painkillers are prescribed.
2. Bleeding. Some patients suffer from bleeding complications. If blood loss is severe, a blood transfusion or surgery to eliminate bleeding is necessary.
3. Damage to adjacent structures. A similar complication usually occurs with a blind method of obtaining a biopsy, when the doctor can damage the gallbladder, lungs, etc. with a needle.
4. Infection. Typically, this consequence is relatively rare. It occurs when bacterial agents enter the abdominal cavity through a cut or puncture.

Post-procedure care

Only puncture liver biopsy is performed on an outpatient basis; in other cases the patient is hospitalized.

Approximately 4-5 hours after the procedure, doctors monitor the patient’s condition, conduct ultrasound diagnostics, monitor blood pressure readings, and conduct an examination.

If there are no negative symptoms such as unbearable pain and bleeding, then the patient is discharged.

For the first day, you must stop driving vehicles, and the next week involves stopping the use of anti-inflammatory drugs, avoiding intense physical labor and thermal procedures (warming up, sauna, bathhouse).

There are percutaneous liver punctures and targeted ones, under the control of a laparoscope or ultrasound. Liver punctures under laparoscope or ultrasound control are most effective for focal liver lesions. For diffuse changes in organ tissue, a “blind” biopsy can be used, and although the location of the liver tissue cannot be determined, a high percentage of positive results is achieved, and the ease of execution makes it accessible to any hepatology department.

In cases of coagulation disorders, massive ascites, small liver size or lack of contact with the patient, as well as fulminant hepatic failure, a transjugular liver biopsy is used using a Trucut needle placed in a catheter inserted through the jugular vein into the hepatic vein.

Among the puncture needle systems, the most widely used are the Menghini needle and the Trucut needle (a modification of the Silverman needle). A number of other systems are also used.

A liver biopsy is performed with the patient in the supine position. The skin at the puncture site (usually the ninth and tenth intercostal space on the right between the anterior and middle axillary lines) is treated with an antiseptic solution. After this, local anesthesia of the skin, subcutaneous fatty tissue and liver capsule is performed with a 2% novocaine solution.

The puncture is made with a stylet, inserting it to a depth of 2-4 mm. Then a Menghini puncture needle is inserted through the stylet (in pediatric practice a shortened needle is used), connected to a 10-gram syringe containing 4-6 ml of isotonic sodium chloride solution. The needle is passed to the liver capsule and 2 ml of isotonic sodium chloride solution is released to push pieces of adipose tissue out of the needle. A needle is inserted into the liver parenchyma and pieces of organ tissue are aspirated using the syringe plunger. After the manipulation is completed, a sterile sticker is applied and an ice pack is placed at the puncture site. The patient remains in bed for 24 hours.

It is not advisable to perform a liver puncture if there is congestive jaundice or pustular rashes on the skin (especially at the site of the intended puncture). A liver puncture biopsy should not be performed against the background of an acute respiratory disease, sore throat, or other acute infections.

Based on the tissue column obtained during liver biopsy, one can judge changes in the entire organ, especially in diffuse processes (viral hepatitis, steatosis, reticulosis, cirrhosis, etc.). but a biopsy does not always allow one to diagnose focal liver lesions (granuloma, tumor, abscess, etc.). The absence of portal tracts in the biopsy and the small size of the tissue sample may also be the reason for the lack of information in the biopsy.

The height of the tissue column is 1-4 cm and its weight is 10-50 mg. The tissue sample is usually fixed in a 10% formaldehyde solution in isotonic sodium chloride solution. The preparations are stained with hematoxylin and eosin, the PAS reaction is performed for the presence of connective tissue, etc. In addition, tissue columns obtained from paraffin blocks can be subjected to retrospective examination. To adequately interpret the results, the tissue sample must be at least 2 cm long and contain four portal tracts.