Utilità della biopsia epatica nella gestione dei pazienti con sospetta epatopatia cronica virale

Liver biopsy has a central role in the evaluation of patients with liver disease, for which diagnostic definition requires an accurate pathological anatomy study of the examined tissue. Liver biopsy should be performed solely in patients who can be benefit from this technique, when non-invasive diagnostic methods are not capable of giving useful information or are not available. Certainly, the continuous, innovative development of diagnostic instruments and biochemical tests will reshuffle, in time, the use of this invasive procedure although it has been well proven over past years. We analysed the relevance of liver biopsy by obtaining diagnostic, prognostic, and therapeutical information in patients affected with HCV infection. In 85% of patients with chronic hepatitis C, the hystological data correlate with the suspicion of clinical-laboratory data of non-evolved chronic liver disease, displacing the practical usefulness of liver biopsy as a diagnostic element (except for the occasional possibility of discovering associated clinical pathology not previously suspected). Even if the accuracy of the clinical judgment is lower in the prediction of liver cirrhosis, the possibility of reaching a definite diagnosis of hepatic cirrhosis by laboratory and ultrasonographic data with a high reliability (PPV = 92%) must not be forgotten. Furthermore, the histological evaluation of liver damage is not important in the selection of treatable or non-treatable patients, since histology changes with time and is susceptible to variations, depending upon the cytolitic and flogistic peaks that reflect the different phases of the HCV replicative activity. Moreover, the therapeutical response can be greatly influenced by viral factors, such as genotype and viral load, more than the hystological data of liver damage. The recent development of instrumental and laboratory diagnoses has displaced the role of the liver biopsy, which should be reserved for those cases in which persistent doubts of etiology exist, or in multiple noxae pathogens. The future trend of this discussion is for the hepatologist to select the patient undergoing liver biopsy in a critical way, by careful anamnestic, ultrasonographic and laboratory evaluation.