Hepatology January 2001 (Volume 33, Number
1)<br>The Role of Liver Biopsy in Chronic Hepatitis<br>C
Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes
D,<br>Easley K Hepatology. 2001;33:196-200Hepatitis C is
a<br>leading cause of chronic liver disease
worldwide.<br>While over 80% of those patients who are
acutely<br>infected will subsequently develop chronic
disease,<br>only 20% to 25% will progress to end-stage
liver<br>disease and its complications. The diagnosis of
hepatitis<br>C is confirmed by positive hepatitis C
virus<br>(HCV) serologies -- anti-HCV antibodies
or<br>detectable HCV RNA. In the high-risk individual
with<br>elevated serum aminotransferases, anti-HCV tests have<br>a
positive predictive value of &lt;br&gt;greater
than<br>95%. These studies may be complemented with
HCV-RNA<br>testing to make the diagnosis of chronic hepatitis
C<br>with viremia. However, at present, there are
no<br>accurate noninvasive markers of disease activity
and<br>fibrosis. In this setting, liver biopsy has been used<br>to
exclude other liver diseases &lt;br&gt;and to
determine<br>the histologic stage of disease. Although data
from<br>&lt;br&gt;sequential liver biopsies can provide important
information<br>regarding prognosis and potentially help guide
the<br>management of patients with chronic &lt;br&gt;disease,
liver<br>biopsy is still an invasive procedure with
associated<br>morbidity, mortality, and high cost. Therefore, Saadeh
and<br>colleagues conducted this study to evaluate the
utility<br>of liver biopsy in patients with
chronic<br>hepatitis C, and also calculated a cirrhosis
discriminant<br>score to predict cirrhosis in this
population.<br>Records of patients infected with HCV seen at
the<br>Cleveland Clinic Department of Gastroenterology
between<br>January 31, 1990 and February 1, 1997 were
assessed<br>for the following inclusion criteria: (1)<br>abnormal
alanine aminotransferase level (defined as &gt;<br>40
IU/L on at least 2 separate occasions);
(2)<br>positive enzyme-linked immunosorbent assay antibody<br>for
HCV; and (3) had liver biopsy performed
after<br>serologic testing. One hundred twenty-six patients
met<br>inclusion criteria and were enrolled in
the<br>study.Overall, results reaffirmed the value of liver
biopsy<br>in patients with chronic liver disease.
Findings<br>suggest that after serologic testing indicates
HCV<br>infection, liver biopsy still has an
important,<br>adjunctive role in determining the stage of disease.
Data<br>from liver biopsies showed that there were
no<br>alternative diagnoses (0/126) and that
additional<br>diagnoses were rare (3/126; all of which were variants
of<br>nonalcoholic steatohepatitis). These investigators
also<br>confirmed that liver biopsy was superior to
the<br>discriminant score in predicting cirrhosis. The most
frequent<br>complication of liver biopsy observed in these patients
was<br>pain (generally mild).As these study
authors<br>conclude, until accurate and indirect markers
of<br>fibrosis (ie, noninvasive) are developed and
validated,<br>liver biopsy remains important in the management
of<br>most hepatitis C patients.