A Retrospective Review of the Diagnostic Rate of Liver Biopsy in Abnormal Liver Tests with Non-Diagnostic Serology and Biochemistry

Abnormal liver function tests, defined as values greater than 2 standard deviations above the upper limits of normal, are noted to be present in up to 7.9% of the population in the United States. In about 69% of patients, they are unexplained by current standard serology or biochemistry markers investigating common viral, autoimmune, hereditary etiologies or inborn errors of metabolism [1, 2].Liver biopsy is considered the most accurate means of grading and staging of liver disease. However, there remains some controversy over whether or not it provides overall significant information in terms of establishing an etiology which would then be used to tailor patient management. [3] Moreover, there is the established possibility of sampling error and accompanying procedure complications during liver biopsy, albeit small [3, 4]. A number of studies have suggested that a high percentage of marker negative liver biopsies had fatty infiltration of the liver with varying degrees of inflammation, with mixed reports on whether there is an association with elements of the metabolic syndrome (obesity, diabetes, dyslipidemia) and improvement with reversal of this syndrome [5, 6, 7, 8]. Several other studies have also reported significant progressive liver disease and even cirrhosis in otherwise asymptomatic patients, who were biopsied with seemingly minor chronic elevations of liver enzymes. These findings subsequently significantly impacted the patient’s care [6, 9,10]. However, these were older studies where some biochemical markers were not excluded, and had conflicting conclusions with regards to the diagnostic rate of liver biopsies. [6, 8]. With rapidly advancing imaging technology and biochemical laboratory techniques, the current study seeks to re-evaluate the utility of liver biopsy. Specifically in patients with abnormal liver tests who have had non-diagnostic biochemical or radiographic workup, the rate at which liver biopsy provides a specific diagnosis that can lead to a change to management will be studied.