{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:57:17Z","timestamp":1791665837082,"version":"4.3.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T00:00:00Z","timestamp":1614988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30123704"],"award-info":[{"award-number":["P30123704"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to assess the value of liver biopsy in the evaluation of abnormal liver tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed consecutive liver biopsy specimens performed for evaluation of unexplained abnormal liver tests from 2014 to 2018. Diagnoses were categorized histologically and clinically. We determined whether histologic examination led to a specific diagnosis and whether prebiopsy laboratory variables predicted the underlying etiology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 383 liver biopsy specimens included, chronic hepatitis was the most common histologic (25%) and clinical (17%) diagnosis. Liver biopsy led to a clinical diagnosis in 87% of patients. The most likely clinical diagnoses were autoimmune hepatitis, nonalcoholic fatty liver disease, and drug-induced liver injury (38, 33, and 32 patients, respectively). Using sensitivity, specificity, and positive and negative predictive values, we found that liver tests were not predictive of a specific diagnosis. In patients with no history of liver disease or clinical features of portal hypertension, biopsy specimens revealed histologic cirrhosis in 5% of patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Histopathologic diagnoses were made in 85% of patients undergoing liver biopsy for investigation of unexplained liver tests, leading to a clinical diagnosis in 87% of patients. However, neither liver tests themselves nor their patterns were useful in predicting histologic or clinical diagnoses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqaa225","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T19:13:58Z","timestamp":1602702838000},"page":"259-267","source":"Crossref","is-referenced-by-count":29,"title":["The Utility of Liver Biopsy in the Evaluation of Liver Disease and Abnormal Liver Function Tests"],"prefix":"10.1093","volume":"156","author":[{"given":"Ali","family":"Khalifa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N","family":"Lewin","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roula","family":"Sasso","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don C","family":"Rockey","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA"},{"name":"Medical University of South Carolina Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,6]]},"reference":[{"key":"2021070713340882500_CIT0001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MEG.0000000000000233","article-title":"A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes","volume":"27","author":"Radcke","year":"2015","journal-title":"Eur J Gastroenterol Hepatol."},{"key":"2021070713340882500_CIT0002","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1136\/jim-2018-000788","article-title":"Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter?","volume":"66","author":"Schreiner","year":"2018","journal-title":"J Investig Med."},{"key":"2021070713340882500_CIT0003","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1111\/j.1572-0241.2003.07486.x","article-title":"The prevalence and etiology of elevated aminotransferase levels in the United States","volume":"98","author":"Clark","year":"2003","journal-title":"Am J Gastroenterol."},{"key":"2021070713340882500_CIT0004","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.cld.2019.09.004","article-title":"Liver histology: diagnostic and prognostic features","volume":"24","author":"Gasmi","year":"2020","journal-title":"Clin Liver Dis."},{"key":"2021070713340882500_CIT0005","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/S0140-6736(08)60383-9","article-title":"Liver cirrhosis","volume":"371","author":"Schuppan","year":"2008","journal-title":"Lancet."},{"key":"2021070713340882500_CIT0006","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.cld.2015.10.011","article-title":"Histology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults and children","volume":"20","author":"Kleiner","year":"2016","journal-title":"Clin Liver Dis."},{"key":"2021070713340882500_CIT0007","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1136\/flgastro-2018-101139","article-title":"Medical liver biopsy: background, indications, procedure and histopathology","volume":"11","author":"Boyd","year":"2020","journal-title":"Frontline Gastroenterol."},{"key":"2021070713340882500_CIT0008","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1159\/000440747","article-title":"Role of histopathology in autoimmune hepatitis","volume":"33","author":"Tiniakos","year":"2015","journal-title":"Dig Dis."},{"key":"2021070713340882500_CIT0009","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.3748\/wjg.v13.i19.2693","article-title":"Budd-Chiari syndrome: etiology, pathogenesis and diagnosis","volume":"13","author":"Aydinli","year":"2007","journal-title":"World J Gastroenterol."},{"key":"2021070713340882500_CIT0010","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1097\/00007890-200106150-00014","article-title":"Are parenchymal changes in early post-transplant biopsies related to preservation-reperfusion injury or rejection?","volume":"71","author":"Neil","year":"2001","journal-title":"Transplantation."},{"key":"2021070713340882500_CIT0011","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/hep.510310337","article-title":"Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. 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