Quick answer
Image-guided liver biopsy takes a fragment of liver tissue, by the transparietal or transjugular route depending on the context (coagulation disorders). Performed as a day case under ultrasound guidance, it provides a precise histological diagnosis.
📖 What is percutaneous liver biopsy?
Percutaneous liver biopsy is the removal of liver tissue under ultrasound or CT guidance, using a fine needle inserted through the abdominal wall. It is the reference examination for the histological diagnosis of chronic liver diseases (cirrhosis, hepatitis) and focal liver lesions (primary or secondary tumour).
At Cochin Hospital AP-HP, percutaneous liver biopsy is performed by the Interventional Radiology department, under real-time ultrasound or CT guidance, with a serious complication rate below 0.1%. It is performed as a day case under local anaesthesia.
⚡ Liver biopsy at a glance: key figures
Percutaneous liver biopsy takes a sample of liver tissue, under ultrasound guidance, for a precise diagnosis (hepatitis, cirrhosis, tumour) without surgery.
| Criterion | Data |
|---|---|
| Anaesthesia | Local: well-tolerated procedure; sedation or general anaesthesia if potentially painful |
| Guidance | Ultrasound |
| Complications | Rare (bleeding, pain) |
| Comfort | Medical hypnosis offered as a complement (clinical trial by our team) |
| Coverage | Reimbursed by French health insurance (Assurance Maladie) at Cochin AP-HP: no extra fees |
Sources: Barat M, Ollivier C, Taibi L, Nitsche V, Sogni P, Soyer P, Parlati L, Dohan A, Abdoul H, Revel MP. "Standard of care versus standard of care plus Ericksonian hypnosis for percutaneous liver biopsy: Results of a randomized control trial." Diagn Interv Imaging. 2025;106(3):93-97. A randomized trial showing a significant reduction in pain and anxiety with conversational hypnosis. Data validated by the team of Pr Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.
✅ What benefits can be expected?
Image-guided percutaneous liver biopsy (PLB) consists of taking a fragment of liver tissue with a fine needle, under ultrasound or CT guidance. The expected benefits are:
- Histological diagnosis that is essential for diagnosing liver diseases and assessing focal liver lesions
- Serious complication rate below 0.1%
- Greater accuracy and safety than blind biopsy, by visualising the needle in real time and avoiding vascular structures
- Performed under local anaesthesia as a day case
- The transjugular route also allows measurement of the portal pressure gradient (HVPG) in cases of portal hypertension
📋 Indications
- Diagnosis of diffuse liver diseases (fibrosis, cirrhosis, chronic hepatitis)
- Assessment of fibrosis grade (METAVIR score) before antiviral treatment or a therapeutic decision
- Characterisation of an indeterminate focal liver lesion
- Follow-up after liver transplantation
- Work-up of unexplained cholestasis
- Biopsy of liver metastases for molecular diagnosis
🔧 Procedure
Preoperative work-up: coagulation tests (PT, aPTT, platelets). Anticoagulants stopped according to protocol. Blood typing.
Local anaesthesia at the puncture site. The procedure lasts 15 to 30 minutes. Performed as a day case or with 4 to 6 hours of monitoring.
Ultrasound guidance: identification of the optimal path, avoiding vessels and bile ducts. The needle is passed during a breath-hold.
Sampling: 1 to 3 biopsy cores of 1.5 to 2 cm with an automatic needle (Tru-Cut 16-18G).
Monitoring for 4 to 6 hours: pulse, blood pressure, pain. Return home the same day if there is no complication.
🩺 Transjugular route (TJ-PLB)
When the transparietal route is not feasible (coagulation disorders, abundant ascites, major hepatomegaly), the biopsy is performed by the right transjugular route. A catheter is introduced into the right internal jugular vein (in the neck) under local anaesthesia, then advanced to the hepatic veins to take the biopsy fragments. This approach also makes it possible to measure the hepatic venous pressure gradient (HVPG), which is useful in the assessment of portal hypertension. The transjugular route is also used for TIPS placement.
⚠️ What are the possible complications?
| Complication | Description | Frequency |
|---|---|---|
| Pain in the right shoulder or at the puncture site | Transient, treated with analgesics | Common |
| Haemorrhage | Any severe pain or malaise in the hours following the biopsy must be reported immediately | 1–2 % |
| Subcapsular haematoma | Most often resolves spontaneously | < 2 % |
| Pneumothorax (high puncture) | Rare, monitoring or drainage depending on severity | < 1 % |
- Relative contraindications: severe uncorrected coagulation disorders, anticoagulation not interrupted, abundant ascites (in which case the transjugular route is used)
📐 What are the limitations of this procedure?
In rare cases the sample may be insufficient for a complete analysis, requiring a repeat biopsy. In heterogeneous cirrhosis, a sample may not be fully representative of the whole liver.
🔀 What other diagnostic approaches are possible?
🩸 Non-invasive fibrosis markers
FibroScan®, blood scores (FIB-4, FibroTest®): for some liver diseases, they can avoid or postpone the biopsy.
👁️ Imaging surveillance
For some low-risk focal lesions, imaging surveillance (MRI, CT) may be offered before biopsy.
❔ What happens if I finally decline the biopsy?
You remain entirely free to decide. Your doctor will discuss the alternatives with you: non-invasive fibrosis markers, imaging surveillance, or a treatment decision without histological confirmation depending on the context.
📄 Patient document to download
Patient information sheet
Download our patient sheet before your consultation.
✅ Procedure covered by French health insurance (Assurance Maladie) · No extra fees · Cochin Hospital AP-HP
❓ Frequently asked questions
📚 Scientific references
Dohan A, Guerrache Y, Boudiaf M, Gavini JP, Kaci R, Soyer P. Diagn Interv Imaging. 2014;95:11-15.
Dohan A, Guerrache Y, Dautry R, Boudiaf M, Ledref O, Sirol M, et al. Diagn Interv Imaging. 2015;96:571-577.
🔗 See also
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.