[Importance of liver biopsy in chronic hepatitis C virus infection]

The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis.

1. To evaluate the impact of the calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in the histological assessment. 2. To assess the correlation of prediction of cirrhosis liver based on clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected histological findings not correlating with the clinical picture.

The group was formed by 139 patients. In all patients during the baseline examination the patient's history data were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC values was assessed.

1. Based on calculation of DSC it is possible to predict accurately the existence of cirrhosis of the liver or chronic hepatitis only in 31% patients. In 69% patients even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction. In 8% patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5% patients cirrhosis of the liver was not confirmed despite the presence of clinical signs. 3. The frequency of other histological findings participating in the development of the hepatic lesion in chronic HCV infection was minimal. In the authors group as such only steatosis and toxic damage of hepatic tissue by alcohol were identified. These findings were, however, suspected already before biopsy. Steatosis can be however considered also a manifestation of HCV infection.

The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection.