Liver biopsy in chronic hepatitis C: routine or selective

A percutaneous liver biopsy can be useful in patients with chronic hepatitis C virus (HCV) infection by providing information regarding the stage of fibrosis and grade of inflammation. Expert consensus groups from the United States and Europe have recommended the routine performance of liver biopsy before initiation of antiviral therapy for chronic hepatitis C (1, 2). The purpose of a pretreatment liver biopsy is to distinguish patients most likely to benefit from therapy (i.e., those with moderate inflammation and advanced stages of fibrosis) from patients who may be less likely to benefit (i.e., those with mild inflammation and minimal or no portal fibrosis). A liver biopsy has been shown to be useful in determining the likelihood of progression of liver injury in chronic hepatitis C; moderate or severe inflammation and fibrosis have been associated with a more rapid progression to cirrhosis (3, 4).