The value of clinical, biochemical, ultrasound and liver biopsy data in assessing patients with liver disease.

To determine the value of clinical, biochemical, ultrasound and liver biopsy data in the management of patients with liver disease, eight doctors each assessed 75 case histories. With clinical and biochemical data alone, the predictive accuracy was significantly higher when identifying patients as 'medical' rather than 'surgical' (97 compared with 79%, p less than 0.001). However, when making a specific diagnosis as opposed to classifying into medical and surgical categories, clinical and biochemical information resulted in a much lower predictive accuracy for both medical (67%) and surgical (56%) patients. With ultrasound data the predictive accuracy increased to 91% when identifying patients as 'surgical'; with liver biopsy it increased to 99% when identifying patients as 'medical'. The value of the different data assessed involves more than an evaluation of diagnostic accuracy, and in this study the relative worth of each test was therefore assessed on a five point scale based on the effect of the information on the doctors. This included a willingness to give specific treatment and make a specific diagnosis, as well as classifying patients into medical and surgical categories and the confidence they felt in their diagnoses. After clinical, biochemical and ultrasound information the doctors were only prepared to give specific treatment to 11.9% of the medical and 9.3% of the surgical patients. After liver biopsy data, however, they were willing to give specific treatment to an additional 66.6% of the medical patients and 25% of the surgical patients. Further evidence of the value of liver biopsy information came from an analysis of the changes in the doctors' confidence in a diagnosis. Thus, 96 patients were assigned a correct specific diagnosis with clinical and biochemical data alone but none were considered as 'definitive' by the doctors; when liver biopsy information was provided 59 (61%) were placed in this category.