Role of liver biopsy in management of chronic hepatitis C: A systematic review

  title={Role of liver biopsy in management of chronic hepatitis C: A systematic review},
  author={Kelly A. Gebo and H. Franklin Herlong and Michael S. Torbenson and Mollie Jenckes and Geetanjali Chander and Khalil G. Ghanem and Samer S. El-Kamary and Mark S. Sulkowski and Eric B. Bass},
This systematic review addresses 2 questions pertinent to the need for pretreatment liver biopsy in patients with chronic hepatitis C: how well do liver biopsy results predict treatment outcomes for chronic hepatitis C? How well do biochemical blood tests and serologic measures of fibrosis predict the biopsy findings in chronic hepatitis C? Medline and other electronic databases were searched from January 1985 to March 2002. Additional articles were sought in references of pertinent articles… 

Analysis of histopathological changes that influence liver stiffness in chronic hepatitis C. Results from a cohort of 324 patients.

Transient elastography is a useful method for chronic hepatitis C assessment, and fibrosis is the main predictor of liver stiffness, but activity and steatosis also influence liver stiffness.

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study.

Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further.

Systematic review of the diagnostic performance of serum markers of liver fibrosis in alcoholic liver disease

There are limited numbers of small studies evaluating the accuracy of biomarkers in identifying fibrosis on biopsy in ALD and some showed promise (both HA alone and some panels) in the identification of cirrhosis/severe fibrosis and could be used to rule it out in heavy drinkers.


FibroScan is a new, simple, noninvasive method which is available at the patient’s bedside for quick evaluation of liver fi brosis degree with accuracy similar to that of the FibroTest, especially for the assessment of signifi cant hepatic brosis (F2-F4).

The Practice of Percutaneous Liver Biopsy in a Gastrohepatology Day Hospital: A Retrospective Study on 835 Biopsies

The 4-year activity of a day hospital of gastrohepatology in northern Italy, where 835 subjects underwent liver biopsy between January 2001 and July 2004, accord with indications expressed by international guidelines.

Predictive Ability of Laboratory Indices for Liver Fibrosis in Patients with Chronic Hepatitis C after the Eradication of Hepatitis C Virus

All 3 laboratory indices of fibrosis accurately reflected liver fibrosis in patients with SVR for 5 years despite the normalization of serum liver transaminase activity and the lack of liver inflammation.

The goal of therapy is to prevent complications and death from chronic viral hepatitis [2,4]. Because of the slow evolution of chronic hepatitis over sev-

In patients with chronic hepatitis C and B, the treatment effect on fibrosis progression rate was similarly estimated using FibroTest® or biopsy, both in HCV and HBV infections.



The role of liver biopsy in hepatitis C

It is concluded that liver biopsy should be performed before initiating interferon therapy, and should only be performed in instances when the findings from the biopsy are likely to lead to a change in management of the patient.

Serum aminotransferase levels and histological disease in chronic hepatitis C.

ASAT levels are more useful than ALAT to assess the histological severity of the disease, probably because this mitochondrial enzyme is present in higher quantities in the liver as compared to the cytosolic ALAT, and is more released when tissue damage is more severe.

Serum aspartate but not alanine aminotransferase levels help to predict the histological features of chronic hepatitis c viral infections in adults

Serum AST values correlate well with two of three features of hepatic inflammation and with the extent of liver fibrosis, suggesting that, among other factors, serum AST values should be considered in decisions regarding the need for liver biopsy and treatment in patients with chronic hepatitis C viral infections.

Evaluation of liver histology, ALT elevation, and HCV RNA titer in patients with chronic hepatitis C.

There is a correlation between serum ALT and degree of hepatic injury based on HAI score, but this relationship is weak and probably of no clinical use.

Non-invasive assessment of inflammatory activity and fibrosis (grade and stage) in chronic hepatitis C infection.

The serum IgG level was the best single marker for distinguishing chronic persistent hepatitis from chronic active hepatitis and CL-IV and IgG are of limited use in predicting the histological grade and stage of liver disease in patients with chronic HCV infection.

Diagnostic value of serum markers of connective tissue turnover for predicting histological staging and grading in patients with chronic hepatitis C

These serum fibrotic markers, especially the serum HA test, would be clinically useful for assessing staging and grading in patients with chronic hepatitis C.

Clinical, Virologic, and Pathologic Significance of Elevated Serum Alpha-fetoprotein Levels in Patients with Chronic Hepatitis C

Elevated serum AFP levels were significantly correlated with lower serum albumin levels, advanced fibrosis/cirrhosis, and genotype 1b infection in patients with chronic hepatitis C.

Assessment of liver histology in patients with hepatitis C and normal transaminase levels.

Of patients with normal ALT at time of liver biopsy, a significant minority have cirrhosis or significant hepatic inflammation, and Liver biopsy is essential in HCV infection as a guide to both therapy and prognosis.