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Hepatitis C: Diagnosis and monitoring

Liver biopsy

A liver biopsy is considered to be a very useful method for establishing the extent of liver inflammation and any possible scarring of liver tissue (degree of fibrosis).1 In a biopsy, tissue is removed directly from the liver under a local anaesthetic and examined using a microscope. For the majority of people living with hepatitis C signs of chronic inflammation can be detected in the tissue. It is an invasive (and therefore a tissue-injuring) method which is not entirely risk-free and it is also painful for many people. Complications, such as bleeding, can occur in a small number of people undergoing this procedure.

There are three different methods of doing a liver biopsy: percutaneous, laparoscopic, and transvenous.

For a percutaneous liver biopsy, a local anaesthetic is given to numb the area and a needle is inserted through an incision into the right side to retrieve the tissue sample. An ultrasound image may be used to guide insertion. There may be a sensation of pressure and dull pain during and after the procedure.

A laparoscopic biopsy involves placing a tube (the laparoscope) through an abdominal incision. The laparoscope sends images to a monitor that is used by the doctor to guide removal of tissue samples.

A transvenous biopsy is done by inserting a catheter (tube) into a vein in the neck and guiding it to the liver. A needle then goes into the catheter to remove the tissue sample from the liver. This technique is usually employed when the patient may have blood clotting problems or abdominal fluid.

Fasting is usually required for eight to ten hours before the procedure. Liver biopsy is considered minor surgery, so it is usually done at a hospital on an outpatient basis. Afterwards, the patient needs to lie still for one to two hours before leaving for home. The next eight to twelve hours should be spent in bed. It takes about a week for the incision and the liver to heal and physical exertion should be avoided during that time.


  1. Ishak K et al. Histological grading and staging of chronic hepatitis. J Hepatol 22:696-699, 1995