Liver biopsy and screening for cancer in hepatitis C.(Editorials)

Publication: American Family Physician

Publication Date: 01-NOV-03

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COPYRIGHT 2003 American Academy of Family Physicians

In June of 2002, the National Institutes of Health (NIH) convened a consensus development conference on the management of hepatitis C. (1) This conference differed from a previous conference (2) on management of hepatitis C by including presentations from a detailed systematic review of evidence on key questions (3-6) and presentations by leading experts in the field.

The Consensus Statement makes many important recommendations regarding the management of chronic hepatitis C, but we would like to highlight the evidence on two aspects of management that may not receive as much attention as the issue of treatment choice. These aspects are (1) liver biopsy--should all patients with chronic hepatitis C be referred for biopsy? and (2) hepatocellular carcinoma (HCC)--should patients with chronic hepatitis C be screened for this disease?

Because these are questions that arise when patients are initially diagnosed with hepatitis C, primary care physicians should be familiar with the Consensus Statement and its supporting evidence.

Liver Biopsy

In patients with hepatitis C, liver biopsy provides information about fibrosis and histology that clinicians may use to determine prognosis and treatment. Liver biopsy also helps identify the presence of liver disease related to other causes. Experts at the Consensus Development Conference advocated for the use of liver biopsy primarily because biopsies may help in treatment decisions and allow for monitoring of disease progression, and have a low risk of serious complications (3 percent). (7) In particular, patients have a low risk of progression to cirrhosis if they have persistently normal or slightly elevated alanine transaminase levels with minimal or no fibrosis on biopsy. Such patients may think that the potential adverse effects of antiviral treatment may outweigh the potential benefit...

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