An ultrasound-guided liver biopsy is a routine procedure in which doctors remove a small piece of liver tissue for analysis in a lab. Your doctor might recommend this procedure if they suspect there may be a problem such as cancer or other liver disease.

Ultrasound is a type of imaging that uses sound waves to produce a moving image of an internal organ on a computer screen. Ultrasound images can help guide your doctor to the site of a lump, mass, or other concerning area of the liver.

The procedure is generally safe and effective in helping to diagnose liver problems. It’s typically an outpatient procedure, so you don’t have to stay in the hospital overnight, and results are usually available in a few days.

Doctors consider ultrasound-guided liver biopsy “the gold standard” in diagnosing liver problems, including:

  • liver cancer
  • hepatitis
  • cirrhosis

A biopsy is helpful when a blood test or imaging tools can’t confirm a diagnosis.

Your doctor also may order an ultrasound-guided liver biopsy to better understand the severity of liver disease or the degree of damage your liver has endured. In some cases, your doctor may perform a liver biopsy to help determine the best treatment or gauge how well your current treatment is working.

Aside from percutaneous biopsy, which uses a needle to penetrate your skin and reach your liver directly, there are two other main types of liver biopsies.

In a transjugular liver biopsy, medical staff insert a needle through your jugular vein in your neck and pass it through your veins down to your liver. According to the National Institute of Diabetes and Digestive and Kidney Diseases, people with higher bleeding risks or who have a buildup of fluid in the abdomen caused by cirrhosis may prefer this type of biopsy.

The other type of liver biopsy is a surgical liver biopsy. You may have this if you’re having surgery for other conditions.

Ultrasound-guided vs. CT-guided liver biopsy

Ultrasound isn’t the only guided approach to a liver biopsy. Your doctor may instead suggest computed tomography (CT). CT is a special type of X-ray imaging that captures scans of an organ from several angles and produces a 3D image on a computer screen.

According to 2017 research, ultrasound has several benefits over CT, including:

  • wider availability
  • lack of radiation
  • shorter procedure time

A 2014 study suggests that while ultrasound is preferred, CT may be a better choice if doctors can’t locate the affected liver tissue using ultrasound.

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As with any invasive procedure, an ultrasound-guided liver biopsy carries risks of infection and bleeding problems at the site of the biopsy.

However, a 2021 study of more than 700 individuals undergoing liver biopsy suggests that ultrasound-guided liver biopsy results in a relatively low risk of bleeding complications.

Once you’re at the hospital, you’ll change into a hospital gown and be given a brief physical assessment before the biopsy.

Prior to the actual biopsy, you’ll lie down on an examination table with your stomach uncovered. The technician will spread a warm gel across your abdomen. This gel helps carry sound waves from the ultrasound machine to the liver.

The technician will then place a transducer, which looks like a small microphone, over the part of the liver your doctor wants to examine. You may feel some slight pressure from the transducer but no pain.

Your doctor will view the ultrasound images on a nearby computer screen. Once your doctor identifies the area of concern in the images, a nurse will clean your abdomen. They’ll also numb the area around the insertion point with an injectable anesthetic.

The team will instruct you on what will happen and what you need to do. At certain points in the procedure, you’ll need to hold your breath for a few seconds, as the liver moves slightly when you exhale and inhale.

Your doctor will then insert a needle through your skin to your abdomen and the location pinpointed by the ultrasound. Once the needle reaches the suspicious tissue, a special device at the end of the needle will remove a small piece of tissue. You may hear a sound when the device is activated.

Your doctor will then pull the needle out. A nurse or technician will clean and bandage the injection site.

At least a week prior to your procedure, you should talk with your healthcare team about adjustments to your medications and any other precautions you should take.

For example, they may advise you to avoid blood-thinning medications or aspirin for up to a week before the procedure. Be sure you get specific guidance on these or other medications. Don’t just stop taking any medication on your own without consulting with your doctor.

You’ll probably also have a blood test in the days leading up to the biopsy. If you don’t have a blood test, you may have to have blood drawn before the procedure.

You’ll have to avoid eating or drinking for about 6 to 8 hours before the biopsy. Taking certain medications with water may be permissible.

After the procedure, the injection site will be cleaned and bandaged. After 3 or 4 hours, you can go home, though you’ll need someone to drive you.

As the local anesthetic wears off, you’ll likely feel some pain at the injection site. The pain may radiate upward toward your shoulders.

Once you are home, you should avoid heavy lifting for a few days. You should be able to resume most of your regular activities within a day or two.

The lab should send the results from the biopsied tissue to your doctor’s office in as little as a few days but likely within 2 weeks. Your doctor should then talk with you about the results, whether any further tests are needed, and whether it’s time to develop a treatment plan.

Will I be under anesthesia during an ultrasound-guided liver biopsy?

Your medical team will use a local anesthetic to numb the area where the technician inserts the biopsy needle. No general anesthesia is required.

How long does an ultrasound-guided liver biopsy take?

The procedure should take about 30 minutes, from the time they begin to prepare you until they place a bandage over the injection site.

Will insurance or Medicare cover an ultrasound-guided liver biopsy?

If your doctor determines that a liver biopsy is a medically necessary screening, then Medicare and most other insurance programs should cover the cost of the procedure and the associated lab work.

Your doctor may recommend an ultrasound-guided liver biopsy if there are concerns about the health of your liver. It’s a procedure that is widely performed and usually with great success and few complications.

It’s one of the main tools doctors use to diagnose a liver problem and its severity. It can also help them determine how well your current treatment is working.