The following tests and procedures may also be used to diagnose PBC.
Liver biopsy is often used to diagnose the cause of chronic liver disease that results in elevated liver tests or an enlarged liver. It is also used to diagnose liver tumors identified by imaging tests. In many cases, the specific cause of the chronic liver disease is highly suspected on the basis of blood tests, but a liver biopsy is used to confirm the diagnosis as well as determine the amount of damage to the liver.
Liver biopsy is also used after liver transplantation to determine the cause of elevated liver tests and determine if rejection is present. Liver biopsy is no longer routine for PBC diagnosis. Not only does a liver biopsy help confirm PBC diagnosis, but also stage of the disease.The most common way a liver sample is obtained is by inserting a needle into the liver for a fraction of a second. This can be done in the hospital, and the patient may be sent home within 3 to 6 hours if there are no complications.
The physician determines the best site, depth, and angle of the needle puncture by physical examination or ultrasound. The skin and area under the skin are anesthetized, and a needle is passed quickly into and out of the liver. The liver tissue is then examined under a microscope to help identify the cause or stage of liver disease. Approximately half of individuals have no pain afterwards, while another half will experience brief localized pain that may spread to the right shoulder.
Less commonly used biopsy techniques are laparoscopy, transvenous or transjugular liver biopsy, and surgical liver biopsy. Surgical liver biopsy may be done at the time a patient undergoes an open abdominal operation, enabling the surgeon to inspect the liver and take one or more biopsy samples as needed.
MRE – Magnetic Resonance Elastography (MRE) is the most accurate for detecting liver fibrosis, particularly early-stage disease.
MRI – Magnetic Resonance Imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the belly. In many cases MRI gives information about structures in the body that cannot be seen as well with an X-ray, ultrasound, or CT scan.
Ultrasound – Ultrasound exam may be performed to visualize the bile ducts to exclude an obstruction and prior to liver biopsy.
Fiberscan – NHA the Fibroscan device (Echosens) works by measuring shear wave velocity, and is not invasive.