Biopsy (done with local anesthetic) is still the “gold standard” to determine the degree of liver scarring and inflammation.
Many care providers do not yet know about non-invasive techniques, and insurance providers may be reluctant to change their requirements until they are convinced that cheaper, better alternatives are available. In many areas, high cost-initial outlay equipment such as Fibroscan machine, is not yet available, and expense may not be justified in areas of low population density. Therefore, biopsy is still heavily relied upon as the prime diagnostic tool for measuring the extent of liver disease.
The test is given while you are lying down, and an ultrasound machine is usually used to help guide the biopsy needle to the perfect insertion point. They need you to breathe in, then hold very still at this point, which is why you need to be totally conscious.
The main pain you will feel is when they administer the local anesthetic, rather like going to the dentist and getting novocaine. Sometimes the biopsy itself is painful, though usually it’s more like a dull ‘thud’, depending on the location of nerves and both the placement and degree of local anesthetic administered. Even if it hurts, however, the pain is generally over so fast that by the time it is noticed, it has stopped.
You will probably also be given a mild sedative. Patients usually have to spend several hours in the hospital to make sure there is no bleeding or other complications, and will need to be driven home by someone else.