Is Liver Biopsy Useful in the Evaluation of Patients with Chronically Elevated Liver Enzymes?

作者：Michael M. Van Ness, Anna Mae Diehl · 发表于：Annals of Internal Medicine · 年份：1989 · DOI：10.7326/0003-4819-111-6-473 · 被引用次数：216 · 研究领域：Liver Disease Diagnosis and Treatment、Alcohol Consumption and Health Effects、Liver Disease and Transplantation

STUDY OBJECTIVE: To determine the diagnostic usefulness of percutaneous liver biopsy in evaluating patients with chronically elevated liver-associated enzymes. DESIGN: Comparison of diagnosis made before biopsy by one physician on the basis of a noninvasive work-up (history, physical examination, laboratory values, and imaging studies) and final diagnosis made after biopsy by a second physician formulated after review of all available noninvasive information and study of the biopsy specimen. SETTING: Referral-based gastroenterology clinic at a U.S. Navy medical center. PATIENTS: Sequential sample of 107 patients with elevated liver-associated enzymes for a minimum of 3 months. Ninety patients were eligible for study. INTERVENTIONS: The final diagnosis made by the second physician blinded to the first clinician's diagnosis served as the criterion standard. MEASUREMENTS AND MAIN RESULTS: Four diagnostic groups were selected for analysis: Alcoholic liver disease, fatty liver, chronic necroinflammatory diseases, and miscellaneous. The positive predictive value of the prebiopsy diagnosis ranged from 88% (CI, 75% to 100%) for alcoholic liver disease to 56% (CI, 37% to 75%) for fatty liver. Higher elevations of transaminase values (greater than three times the upper limit of normal) correlated positively with increased prebiopsy diagnostic accuracy. Fatty liver was present in 19% of the cohort. Liver diseases requiring specific therapy other than alcohol abstinence were overlooked a...