The role of liver biopsy in chronic hepatitis C

Abstract

The report of the 1997 National Institutes of Health Consensus Development Conference on hepatitis C endorsed pretreatment liver biopsy. We revisit the following questions: Does liver histology help determine the urgency of, and predict the likelihood of response to, antiviral therapy, and can surrogate markers supplant histological assessment? Because the rate of progression of chronic hepatitis C is influenced by baseline histological grade/stage, patients can be stratified into those with moderate to severe hepatitis, who merit imminent therapy, and those with mild hepatitis, in whom therapy can be postponed until more effectiveholerable treatments become available. Less advanced baseline histology has been shown to be an independent predictor of responsiveness to antiviral therapy. Although the predictive value of biopsy is insufficient to withhold therapy from patients with advanced fibrosis, baseline biopsy helps gauge expectations for the outcome of therapy. Reports have been published recently suggesting that laboratory markers can predict distinctions between low-grade fibrosis and therapy-indicating septal fibrosis/cirrhosis. These indices, however, are insufficiently reliable to predict histological distinctions in populations with varying prevalences of fibrosis/cirrhosis or to provide anything more than broad qualitative distinctions, far short of the potential information in a liver biopsy. For most patients, the value of pretreatment liver biopsy outweighs its risks, provides information about the urgency of treatment, and should be retained. Studies to identify noninvasive laboratory markers of histological activity and stage, especially genetic predictors of accelerated disease progression, command a high priority. (HEPATOLOGY 2002;36:S152-S160.) s the efficacy of therapy for chronic hepatitis C improves, as acceptance of such therapy becomes A more widespread, and as management of chronic hepatitis C extends from specialist hepatologists to nonspecialists, the role of liver biopsy in the management of chronic hepatitis C is being re-examined. When the role of liver biopsy was considered during the previous NaAbbreviations: HAL histology activity index; HCK hepatitis C virus; AL T, alanine aminotransferax; AST, aspartate aminotransferase.

Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C: A meta-analysis of individual patient data

“…1 The histologic findings on biopsy also enable the clinician to evaluate the probability of a response to interferon alfa-2a (IFN). 2 Liver histology provides direct evidence of hepatic necroinflammatory activity, fibrosis, and progression to cirrhosis, 3 and is a surrogate endpoint of the longterm efficacy of IFN treatment.…”

Diagnosing Fibrosis in Hepatitis C: Is the Pendulum Swinging From Biopsy to Blood Tests?

“…2 The liver biopsy is not necessary to make the diagnosis and rarely is it of value in excluding secondary diagnoses such as coexistent, autoimmune, iron, nonalcoholic steatohepatitis or alcohol-induced injury. The major clinical utility of the index biopsy in HCV is to enable the clinician to determine the need for therapy.…”

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

“…By then, liver transplantation was also established. [22][23][24] Currently, noninvasive tests which are simple to perform are widely available and reproducible have replaced LB. 7,10-12,25 Ultrasound-based imaging can differentiate between fibrosis stages III-IV from 0 to II but cannot differentiate stage 0-II or between III and IV.…”