This article reviews the ways in which liver biopsy provides SELECTION OF THE PATIENT a resource to the clinician when making management deci-Liver biopsy in patients with chronic hepatitis C virus sions for patients with chronic hepatitis C. Liver biopsy pro-(HCV) infection is indicated when persistent or intermittent vides information about the extent and distribution of inflamabnormalities in alanine aminotransferase (ALT) levels are mation and allows grading and staging of the disease (the observed (รบ6 months) or when an alternative diagnosis such amount of fibrosis). Furthermore, the liver biopsy allows as alcohol-induced liver disease, non-alcohol-induced stesome assessment of the rate of disease progression whenever atohepatitis, or hemochromatosis is being considered. Liver the date of onset of infection is known. The presence of diffuse biopsy is contraindicated in instances of severe coagulopathy fibrosis or cirrhosis correlates with a lower likelihood of reand when obvious features of end-stage liver disease are pressponse to antiviral therapy, and the finding of severe necroinent, not only because of the inherent clotting problems these flammatory and fibrotic changes is helpful in determining the patients manifest, but also because of the limited amount of relative importance of beginning treatment early rather than new information provided. deferring therapy. The importance of liver biopsy in the selec-
The role of liver biopsy is less clear in patients with hepatition of patients for treatment is underscored by the fact that tis C infection and normal ALT levels. Although many of hepatitis C is a condition in which therapy is currently unable these patients will be found to have underlying features of to successfully treat the majority of patients. There are no hepatitis, these are often mild in nature. [1][2][3][4][5] Moreover, because strong correlations between serum viral RNA, alanine aminothe response to therapy has been poor in this group of patransferase (ALT) levels, and liver histopathology; therefore, tients, 6 it is preferable to treat them in established research the utility of aminotransferases and hepatitis C virus (HCV) protocols only.
RNA as surrogate tests for measuring disease activity in individual cases is limited. It is concluded that liver biopsy should RISKS INHERENT TO LIVER BIOPSY be performed before initiating interferon therapy. At the pres-
The disadvantages of liver biopsy may be divided into three ent time, it is not known if and when repeat histological basic areas: the risk of complications; occasional poor patient assessment is necessary. Preferably, it should only be peracceptance, which may occur if a prior biopsy was performed formed in instances when the findings from the biopsy are with great difficulty; and expense. The latter can be minilikely to lead to a change in management of the patient. (HEPAmized by performance of this procedure as an outpatient.