There are several methods of obtaining biopsies of the liver, but unless it is an unusual situation, the most common method is percutaneously (”through the skin”). A percutaneous biopsy involves numbing a small area of skin over the lower right side of the chest (this site is directly over the liver).

A local anesthetic (usually Lidocaine or Novocaine) is injected with a needle. The needle is introduced further with additional injections of anesthetic all the way through the chest wall and into the liver. This numbs the tract that the biopsy needle will take and reduces discomfort.

Next, a special biopsy needle is inserted into the same area, and, with the patient holding his or her breath, the biopsy needle is inserted quickly into the liver and withdrawn. (The insertion and withdrawal of the biopsy needle takes only a second or two.) Suction through the needle, applied via an attached syringe, causes a small piece of liver (the biopsy) to be pulled into the needle and cut off from the rest of the liver. Other types of biopsy needles have a spring loaded cutting mechanism to obtain the liver tissue without the use of the syringe suction.

If there is a question about the exact position of the liver or a specific part of the liver is to be biopsied, an ultrasound of the liver may be performed before the biopsy to determine the exact direction for the biopsy needle to be inserted.

There may be varying amounts of discomfort at the site of the biopsy especially after the effect of the anesthetic wears off. Most patients have minimal pain, but some require medication for pain which lasts up to a few hours.