LIVER BIOPSY IN CHRONIC HEPATITIS: USE OR ABUSE?

This is a prospective study that determined the usefulness of liver biopsy in the evaluation of patients with chronically elevated liver enzymes. The study involved 90 active or retired military personnel who previously had undiagnosed liver disease and who had been referred to the Bethesda Naval Hospital GI clinic for evaluation of chronic elevation of liver‐related enzymes. Inclusion criteria were elevation of SGOT, SGPT, Alkaline phosphatase of liver origin, or GGTP to 1.5 times the upper limit of normal for at least 3 months. The patients then underwent the following evaluation 1) history and physical examination, 2) serologic studies, including hepatic chemistries, serum protein electrophoresis, antinuclear and antimitochondrial antibodies, iron studies, ceruloplasmin, α₁‐antitrypsin, HIV, and hepatitis screening 3) imaging studies. Suhsequently, a “clinical” diagnosis was made prior to percutaneous liver biopsy. Biopsies were then obtained on all patients and interpreted blindly. All of the clinical and laboratory data, including liver biopsy results, were used to determine a “final” diagnosis. This final diagnosis served as the gold standard from which all comparisons were based. They found that the clinical diagnosis was correct in fatty liver disease, necroinflammatory liver disease, and alcoholic liver disease, with a positive predictor value of 56%, 81%, and 88%, respectively. The results of liver biopsy altered the therapeutic decisions in 10% of patients (9/90). This included four patients who were misdiagnosed as having granulomatous liver disease, two without chronic autoimmune liver disease, and two without granulomatous liver disease.