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. 2009 May 14;15(18):2190-203.
doi: 10.3748/wjg.15.2190.

Non-invasive assessment of liver fibrosis in chronic liver diseases: implementation in clinical practice and decisional algorithms

Giada Sebastiani  1
Affiliations

Non-invasive assessment of liver fibrosis in chronic liver diseases: implementation in clinical practice and decisional algorithms

Giada Sebastiani. World J Gastroenterol. .

Abstract

Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications, including decompensation, bleeding and liver cancer. Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease. Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis, while cirrhosis requires a specific follow-up including screening for esophageal varices and hepatocellular carcinoma. Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive, costly and prone to sampling errors. Recently, blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis. However, there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available. This is due to an unsatisfactory accuracy for some of them, and to an incomplete validation for others. Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined. Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.

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Figures

Figure 1
Figure 1
The SAFE-biopsy algorithm for significant fibrosis (≥ F2 by METAVIR). The figure reports the cut-offs used for APRI and Fibrotest in the decisional tree.
Figure 2
Figure 2
The SAFE-biopsy algorithm for cirrhosis (F4 by METAVIR). The figure reports the cut-offs used for APRI and Fibrotest in the decisional tree.
Figure 3
Figure 3
Diagnostic algorithms for implementation of non-invasive methods for liver fibrosis in clinical practice based on the local availability of the most validated methods.
Figure 4
Figure 4
Perspectives for the use of non-invasive markers for long term monitoring of chronic liver diseases.
See this image and copyright information in PMC

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