Is Liver Biopsy Useful in the Evaluation of Patients with Chronically Elevated Liver Enzymes?

Abstract

The cause of chronic liver disease is best elucidated when the noninvasive work-up is complemented by review of a biopsy specimen.

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

“…There is also relatively small interobserver variation in the histological interpretation of ALD with greater agreement in samples containing more than 6 portal tracts (41). However, the practitioner is more adept at diagnosing ALD than other causes of liver disease on clinical grounds alone (42,43), but it is more difficult to precisely define the type of liver disease in alcoholic patients (44). In a cohort of educated, middle to upper income, military personnel studied by Van Ness (42), the sensitivity and positive predictive value of a clinical diagnosis of ALD were 91% and 88%, respectively.…”

“…However, the practitioner is more adept at diagnosing ALD than other causes of liver disease on clinical grounds alone (42,43), but it is more difficult to precisely define the type of liver disease in alcoholic patients (44). In a cohort of educated, middle to upper income, military personnel studied by Van Ness (42), the sensitivity and positive predictive value of a clinical diagnosis of ALD were 91% and 88%, respectively. The negative predictive value and the specificity were also excellent at 97% and 96%, respectively (42).…”

“…In a cohort of educated, middle to upper income, military personnel studied by Van Ness (42), the sensitivity and positive predictive value of a clinical diagnosis of ALD were 91% and 88%, respectively. The negative predictive value and the specificity were also excellent at 97% and 96%, respectively (42). In another well performed retrospective series, the prebiopsy diagnosis of ALD was 98% specific and 79% sensitive (45).…”

“…Therefore, when the clinical diagnosis seems certain, the biopsy is usually confirmatory. Conversely, when there is an uncertain clinical diagnosis, a biopsy will frequently be useful (42,49). However, many of the studies comparing the accuracy between the clinical diagnosis and liver biopsy for ALD were done before the recognition of hepatitis C. Some workers have ascribed some histological changes of chronic hepatitis to alcohol (38,50), whereas in fact some of these patients had hepatitis C (51,52).…”

Non-alcoholic fatty liver disease (NAFLD) - A novel common aspect of the metabolic syndrome

“…Mild to moderate elevation of ALT or AST or both are the most common findings (with the AST:ALT ratio <1) and, according to recent estimates, NAFLD is the most frequent cause of abnormal liver function tests and abnormal liver enzymes on routine blood testing that should be considered as a first presentation of NAFLD or NASH 1,3,15,27 . However, it has been shown that the degree of ALT elevation does not correlate with liver histology 24,28 . In patients with NAFLD without manifestation of a more advanced liver disease, the common finding on physical examination may be hepatomegaly 1,29 .…”