The role of liver biopsy in the management of patients with nonspecific chronic liver enzyme abnormalities is not well established.
Researchers from Rochester, Minnesota, USA assessed whether liver histology changes the clinical impression formed before liver biopsy and the preliminary management plan.
Consenting asymptomatic adult patients with persistent (6 months) liver test abnormalities were enrolled. There were a total of 36 patients: 15 men and 21 women, with a median age of 51 yr. Patients with a strong suspicion for a specific liver disease were excluded.
Liver biopsy changed diagnosis in 14% of cases
A presumptive diagnosis and a preliminary management plan were documented before a liver biopsy. After the liver biopsy, the patients were reassessed to determine the effect of the biopsy on the diagnosis and management plan.
The prebiopsy diagnoses were nonalcoholic steatohepatitis (24), autoimmune hepatitis (3), primary biliary cirrhosis (2), primary sclerosing cholangitis (2), and miscellaneous (5 patients). The liver biopsy changed the diagnosis in 14% of cases. Lifestyle recommendations were not significantly altered by the biopsy. The liver biopsy affected the frequency of liver test monitoring in 13 patients (36%). Treatment recommendations were affected in 12 cases, 10 of whom were offered investigational therapy.
The authors concluded that, "Although a liver biopsy may help to definitively establish the final diagnosis in patients, the results alter the presumptive prebiopsy diagnosis infrequently, and no proven therapy exists for the vast majority of these patients.
"The risks and benefits of a liver biopsy should be carefully weighed, especially in settings in which investigational therapies are unavailable."