Non-invasive assessment of liver fibrosis

Abstract

The presence and degree of hepatic fibrosis is crucial in order to make therapeutic decisions
and predict clinical outcomes. Currently, the place of liver biopsy as the standard of reference
for assessing liver fibrosis has been challenged by the increasing awareness of a number of
drawbacks related to its use (invasiveness, sampling error, inter-/intraobserver variability). In
parallel with this, noninvasive assessment of liver fibrosis has experienced explosive growth
in recent years and a wide spectrum of noninvasive methods ranging from serum assays to
imaging techniques have been developed. Some are validated methods, such as the Fibrotest/
Fibrosure and transient elastography in Europe, and are gaining a growing role in routine clinical
practice, especially in chronic hepatitis C. Large-scale validation is awaited in the setting
of other chronic liver diseases. However, noninvasive tests used to detect significant fibrosis
and cirrhosis, the two major clinical endpoints, are not yet at a level of performance suitable
for routine diagnostic tests, and there is still no perfect surrogate or method able to completely
replace an optimal liver biopsy. This article aims to review current noninvasive tests for the
assessment of liver fibrosis and the perspectives for their rational use in clinical practice.

Keywords liver fibrosis, non-invasive, transient elastography, serum biomarkers, liver biopsy

Ann Gastroenterol 2012; 25 (2): 218-231