Usefulness of a liver biopsy in the evaluation of patients with elevated ALT values and serological markers of hepatitis viral infection - An AIGO study

Our study objective was to determine the current use of liver biopsy in chronic viral hepatitis and how patient management is affected by the procedure. Members of the Italian Association of Hospital Gastroenterologists were asked to complete a questionnaire for patients submitted to biopsy. Their clinical diagnosis was compared with the histological diagnosis. Of 660 patients evaluated, we selected 535 cases with viral infection. Concordance of clinical vs histologic diagnosis amounted to 84.3%, with 92.7% sensitivity acid 32.4% specificity rates for diagnosing chronic hepatitis; the clinical diagnosis was correct in only 24 of 57 cases with cirrhosis. In 20 cases (3.7%) additional diagnoses were provided. The biopsy was rated avoidable in 36.8% of cases. Knowledge about grading and staging was considered of value in 59.6 and 66.4% of cases, respectively; however, when it became available, the scheduled treatment with interferon was not changed in 81.7 and 80.9% of cases. In the majority of patients with abnormal ALT and infection with HCV and/or HBV, histology documents mild/moderate inflammation with minimal fibrosis and liver biopsy neither increases the accuracy of clinical diagnosis nor affects the choice of therapy. The data from this study support the view that liver biopsies are less helpful than conventionally understood.