Abstract
BackgroundSince the introduction of molecular diagnostic tools such as markers for hepatitis C and different autoimmune diseases, liver biopsy is thought to be useful mainly for staging but not for diagnostic purposes. The aim was to review the liver biopsies for 5 years after introduction of testing for hepatitis C, in order to evaluate what diagnostic insights – if any – remain after serologic testing.MethodsRetrospective review of all liver biopsies performed between 1.1.1995 and 31.12.1999 at an academic outpatient hepatology department. The diagnoses suspected in the biopsy note were compared with the final diagnosis arrived at during a joint meeting with the responsible clinicians and a hepatopathologist.ResultsIn 365 patients, 411 diagnoses were carried out before biopsy. 84.4 % were confirmed by biopsy but in 8.8 %, 6.8 % and 10.5 % the diagnosis was specified, changed or a diagnosis added, respectively. Additional diagnoses of clinical relevance were unrecognized biliary obstruction and additional alcoholic liver disease in patients with chronic hepatitis C. Liver biopsy led to change in management for 12.1 % of patients.ConclusionEven in the era of advanced virological, immunological and molecular genetic testing, liver biopsy remains a useful diagnostic tool. The yield is particularly high in marker negative patients but also in patients with a clear-cut prebiopsy diagnosis, liver biopsy can lead to changes in patient management.
Highlights
Since the introduction of molecular diagnostic tools such as markers for hepatitis C and different autoimmune diseases, liver biopsy is thought to be useful mainly for staging but not for diagnostic purposes
Liver biopsy has been the gold standard for diagnosing liver disease; the detection of the hepatitis C virus and the development diagnostic testing [1], the development of criteria for autoimmune hepatitis [2] as well as the detection of novel autoantibodies [3] makes diagnosis of many liver diseases based on virological and serological testing much easier and precise
The number of changed diagnoses is similar to that reported in asymptomatic patients from the Mayo clinic [9] and – surprisingly – remains comparable to that others and ourselves had reported in the pre-hepatitis C testing era [10,4]
Summary
Since the introduction of molecular diagnostic tools such as markers for hepatitis C and different autoimmune diseases, liver biopsy is thought to be useful mainly for staging but not for diagnostic purposes. The aim was to review the liver biopsies for 5 years after introduction of testing for hepatitis C, in order to evaluate what diagnostic insights – if any – remain after serologic testing. Liver biopsy has been the gold standard for diagnosing liver disease; the detection of the hepatitis C virus and the development diagnostic testing [1], the development of criteria for autoimmune hepatitis [2] as well as the detection of novel autoantibodies [3] makes diagnosis of many liver diseases based on virological and serological testing much easier and precise. The aim of the present study was to evaluate the diagnostic value of liver biopsy in the era of testing for hepatitis C. To this effect, we retrospectively analyzed the 380 liver biopsies performed between 1.1.1995 to 31.12.1999 in our department.
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