Dedicated to accelerating the acceptance and adoption of noninvasive technologies as an alternative to biopsy

Biopsy Basics

Liver biopsy is an invasive diagnostic procedure, long considered the gold standard for diagnosing and staging liver disease such as Nonalcoholic Fatty Liver Disease (NAFLD) or Nonalcoholic Steatohepatitis (NASH). 

Biopsy falls far short of a gold standard: It is invasive, potentially inaccurate, and carries risk to patients.

A biopsy allows examination of only 0.002% of the liver, and more than 30% of liver biopsy diagnoses may be wrong. 

Ask Your Doctor Before the Biopsy

  • What is the reason for doing the biopsy?

  • What are the noninvasive alternatives?

  • How experienced is the radiologist/physician performing the procedure?

  • What are the processes for minimizing pain and discomfort?

  • How is the risk of bleeding minimized?

  • How soon will I get the results?

Complications of Biopsy

Complications are rare, but can occur. Complications of Biopsy include:

  • Bleeding 

  • Pneumothorax 

  • Hemothorax 

  • Perforation of viscous organs 

  • Inadvertent biopsy of the kidney 

  • Bile peritonitis 

  • Infection (bacteremia, abscess, sepsis) 

  • Hemobilia 

  • Death 

Alternatives to Biopsy 

In some circumstances, a liver biopsy is extremely valuable, helpful, and perhaps even necessary, but in other circumstances noninvasive technologies can be used to avoid liver biopsy. These noninvasive alternatives potentially provide more information than biopsy, through their ability to assess changes throughout the liver, rather than only in the relatively small amount of liver tissue typically obtained from a liver biopsy.

From blood tests to imaging, alternatives to biopsy exist. Healthcare providers should increase the number of diagnoses and decrease the number of liver biopsies using noninvasive technologies. 

What noninvasive technologies are there?

  • Blood tests: Different tests on the blood to calculate the amount of fat in the liver. They can be imprecise and not reflect the true degree of liver fibrosis. Specific blood tests include AST to Platelet Ratio Index (APRI), Fibrosis-4 Test (FIB-4), Enhanced Liver Fibrosis (ELF), and FibroTest.

  • Multiparametric Magnetic Resonance Imaging (LiverMultiScan): Imaging technology that uses MRI to measure liver fat, iron, fibrosis and inflammation in a scan of up to 15 minutes.

  • Transient Elastography (Fibroscan): Imaging device that uses ultrasound to measure liver stiffness.

  • Magnetic Resonance Elastography (MRE): Imaging technology that combines MRI with sound waves to create a visual map (elastogram) to measure liver stiffness.

  • Shear Wave Elastography: Imaging technology that uses ultrasound to measure liver stiffness.

Ask your doctor which tests are appropriate in your case.

Going Beyond the Biopsy™

Noninvasive alternatives are necessary to respond to the growing incidence of NAFLD, NASH, and other liver disease. Beyond the Biopsy is the Global Liver Institute’s awareness campaign, dedicated to accelerating the acceptance and adoption of noninvasive technologies as an alternative to biopsy.

 Patient Voices

The biopsy was very frightening. It’s degrading using bedpans, and horrendous lying motionless for hours afterwards. I have since had more biopsies, each one equally painful and traumatic - meaning time off from work for my husband or daughter.

- Jenny, Liver transplant patient who has undergone multiple biopsies

I only found out my diagnosis, NASH, from my discharge papers. I found out what NASH was by looking it up on Google. I definitely would have benefited from point-of-care patient counseling.

- Kimberly, NASH and liver transplant patient

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GLI Thanks Its Beyond the Biopsy™ Sponsor, Perspectum Diagnostics