On the other hand, McNair argued that, since the only proven treatment for NAFLD is weight loss, liver biopsy was pointless. He stated that it is difficult to justify liver biopsy simply to provide better prognostic information. Indeed, it is not clear that patients with simple steatosis and mild fibrosis will not, with time, develop more severe liver disease. Likewise, Kirsch did not feel that liver biopsy in patients with persistently abnormal liver enzymes should undergo a liver biopsy simply to make the diagnosis of NAFLD, since there is no defined therapy and knowing the histology is unlikely to have any clinical impact.
Matteoni and colleagues , in their 18-year study of patients with NAFLD, seem to have provided the answer. They found that patients with an isolated finding of steatosis had a benign course, while those with active inflammation, Mallory bodies, necrosis and fibrosis tend to develop cirrhosis. Therefore, liver biopsy not only provides important prognostic information but also remains crucial in the development of therapeutic protocols for NAFLD .
From the foregoing discussion, it can be seen that the role of liver biopsy in the management of patients with liver disease remains a contentious issue. Therefore, each case should be assessed on its own merits. For many patients, liver biopsy continues to provide important information about the cause and severity of the liver disease, and must be regarded as a crucial part of the patient’s management. Emerging diagnostic tools, such as fibrosis markers, might make it possible to obtain this information noninvasively in the future. In the meantime, liver biopsy is required in selected patients with liver disease.