Abstract
The role of liver biopsy in the asses ment of chronic hepati tis C is generall y accepted yet there is no prosp ctive data avai lableto quantify its contribution. A previous single centre pilot study suggested that the clinic ian could predict the amount of fi brosisand to a lesser extent. in fl ammation with moderate accuracy. The 2002 Nat ional lns! itut of Health Hepatitis C Consensus Conference recommended f urthe r study of the rolc of liver biopsy. Our objective was to compare a prelliction of biopsy fin llings by ex pert clinic ians using usu ally available cIill ical and laboratory data to actual biopsy results in order to determine whethcr bi opsy i, requir d outinely. Th is was a prospecti ve observational study conducted at seven university cen tr s in which th accuracy of clinician's pred ictions of the degre of inflammation and fi brosis were compared with the actual liver biopsy using an adaptatioll of a stundard histo logical scoring system. We tudied 81 adults with previously untreated chronic hepatitis C, raised serum transaminases and positive HCY-RNA in serum. Clinicians predicted the inflammatory grade in 44 of 80 ca es (55%) and th e fibros is stage in 46 o[ 81 Cases (57%).
Nine of 17 cirrhotic cases wcre predicted (sensi tiv ity 53%, specificity 56%). No unexpect d additional diagnoses were macle on the biopsics. Thus desp ite knowlcdge of the c lin ic a l and laboratory in v e~tiga t i ons of patients with hepatitis C, clinicians are unable to accurately pr diet the hepaLic inflammatory grade and fib rotic stage. Liver biopsy is an essential in vc~ tigatio n to accuratel eval uate the grade and stage of li ver disease pat ients with hepati tis C.
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