The Liver Biopsy by Natalie Rock, BScN
The Liver Biopsy from the Canadian Liver Foundation
The Percutaneous Liver Biopsy
The Liver Biopsy Guide from Hepatitis C International
What To Expect at the Hospital by Darlene Morrow, BSc
Guidelines for Diagnostic Laparoscopy authored by the Society of American Gastrointestinal Endoscopic Surgeons
Abstracts and Articles:
Role of Liver Biopsy by Dr. Robert Perrillo
Nomenclature, grading, staging of liver biopsies
The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy
What Serologic Tests are Necessary Before a Liver Biopsy in Patients with Hepatitis C
Relationship of aminotransferases to liver histological status in chronic hepatitis C.
Liver histology in anti-HCV-positive persons with normal or minimally elevated aminotransferases
Evaluation of liver histology, alt elevation and hcv rna titier
Liver biopsy recommended for chronic hcv infection
Non-invasive assessment of inflammatory activity and fibrosis (grade and stage) in chronic hepatitis C infection.
Is liver biopsy necessary prior to treatment of hepatitis C?: economic and medical implications.
Histopathological aspects of viral Hepatitis
A Novel Histological Lesion in Glucocorticoid-Responsive Chronic Hepatitis
EVALUATION OF LIVER
HISTOLOGY, ALT ELEVATION, AND HCV RNA TITER IN PATIENTS WITH CHRONIC
HEPATITIS-C
OBJECTIVE:
Hepatic histological evaluation is currently
the gold standard to determine the degree of liver injury in chronic
hepatitis C. It is unclear whether degree of serum ALT elevation
or quantitative hepatitis C virus (HCV) RNA can predict level
of histological damage,
METHODS:
Fifty nine biopsies from 44 patients with chronic hepatitis C were reviewed, The amount of liver damage was quantified using the Histology Activity Index (HAI) and was compared with serum ALT and, in 26 biopsies, quantitative HCV RNA (branched DNA amplification, Quantiplex, Chiron),
RESULTS:
A statistically significant linear relationship was noted between degree of ALT elevation and amount of liver injury based on HAI score (p < 0.05) although this relationship was not statistically strong (r(s) = 0.4900), No significant correlation was noted between serum ALT and HCV RNA titer (r(s) = 0.4044) or between quantitative HCV RNA titer and HAI score (r(s) = 0.3506), No individual component of the HAI correlated with ALT or HCV RNA,
CONCLUSIONS:
Although there is a correlation between serum ALT and degree of hepatic injury based on HAI score, this relationship is weak and probably of no clinical use, There is no significant correlation between HCV RNA and serum ALT or HCV RNA and degree of hepatic injury in individual patients, Hepatic histological evaluation continues to be required for clinical assessment of patients with chronic hepatitis C.
Authors: MH SJOGREN, WALTER REED ARMY MED CTR, DEPT CLIN INVEST, DEPT GASTROENTEROL, WASHINGTON, DC 20307
Publication: AMERICAN JOURNAL OF GASTROENTEROLOGY 1996 AUG; 91(8):1516-1522
LIVER BIOPSY RECOMMENDED FOR PATIENTS WITH CHRONIC INFECTION
British researchers advised that liver biopsy be performed in all patients with chronic hepatitis C infection.
The purpose of the procedure is to accurately assess the degree of fibrosis as well as current disease activity, stated C.J. Healey, Radcliffe Hospital, Oxford, United Kingdom, and colleagues ("Liver Histology in Hepatitis C Infection: A Comparison between Patients with Persistently Normal or Abnormal Transaminases," GUT, 1995; 37:274- 278).
"In this study we have shown that significant liver disease can be found in hepatitis C infection despite persistently normal transaminases (nearly 50 percent) in our series," Healey et al. wrote.
A previously reported study of Italian patients with hepatitis
C infection also showed ongoing normal liver function during a
time period of 7 to 28 months, yet more than 60 percent of the
patients had chronic persistent or active hepatitis (Bruno, S.,
et al, "Normal Aminotransferase Concentrations in Patients
with Antibodies to Hepatitis C Virus," BMJ, 1994;308:697).
The researchers indicated that hepatitis C virus (HCV) infection could become a growing problem and that continued active assessment and follow-up of all infected patients should be conducted.
"Liver biopsy should be offered as a routine part of this assessment to all cases, as repeatedly normal liver transaminases do not exclude significant liver involvement in many cases," wrote Healey et al. "This will allow for identification of patients suitable for antiviral treatments, reassurance of the patients with normal or minimal disease, and intervention in simple lifestyle measures (for example, reduction in alcohol intake and avoidance of hepatotoxic treatment)."
In the study reported by Healey et al., they investigated 42 cases of confirmed HCV infection with liver histology available. While 55 percent (23/42) of the patients showed abnormal liver function tests, 45 percent (19/42) had liver transaminase levels that were persistently normal.
While the researchers observed serious pathology more frequently in the abnormal transaminase group, they said that they found significant liver pathology - in the form of chronic persistent hepatitis or chronic active hepatitis - in nine of 19 (47 percent) of the patients with repeatedly normal transaminase levels.
The corresponding author for this study is Dr. C.J. Healey, Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
Blood Weekly, 01-01-1995, pp 5.
