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DIAGNOSTIC VALUE OF LIVER BIOPSY IN PATIENTS WITH CHRONIC HEPATITIS C
INFECTION
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Aurelie Fabre 1 ,JaniceMain 2 , Howard Thomas 2 , Graham Foster 2 , Robert
Goldin 1
1 Department of Histoapthology, ICFM at St Mary's, London; 2 Department of
Hepatology, ICFM at St Mary's, London, UK
Liver biopsy in the management of patients infected by the hepatitis C virus
(HCV) is recognised as the gold standard to assess fibrosis (stage) and
inflammation (grade) which are recognised predictors of disease progression
and response to treatment. A 5 year retrospective analysis of 751 liver
biopsies in 651 HCV infected patients identified the presence of additional
histological features which triggered alterations in patients' management,
the latter assessed by review of clinical data. Using a computerised data
collection system, additional features on liver biopsy which were unrelated
to HCV (e.g., iron deposition [n = 14], alcohol-related damage [n = 17],
drug-related changes [n = 10], plasma cell infiltrate [n = 2], features of
diabetes/obesity [n = 5],
evidence of IV drug abuse [n = 3], granulomas [n = 5], and others [n = 11])
were present in 101
(13.4%) (excluding 3 transplant cases, dysplasia [n = 15] and hepatocellular
carcinoma [n = 6]). The additional findings were regarded as informative if
therapeutic action was taken following the histological assessment.
Informative findings led to management changes in 32.7% of patients including
mutational analysis for hereditary haemochromatosis [n = 3], venesection [n =
2], advice to reduce alcohol consumption [n = 6], investigation for
granulomas [n = 4], auto-antibody screening or diabetic control assessment.
This study indicated that liver biopsy in patients with HCV has an important
role in identifying co-existent causes of liver disease and this frequently
alters patient management.
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