[Guidelines Indonesia National consensus (Hepatitis B)]

2012

In Hepatitis B:
'There are two types of liver histological examination: invasive procedure and non-invasive procedure. The gold standard for diagnosis of cirrhosis is liver biopsy which is very uncomfortable and is not practical for monitoring. There are several reports showing that non-invasive method such as Liver Stiffness Measurement (LSM) with Transient Elastography and other serological examination can be applied as the alternative of liver histological examination in case of chronic hepatitis B. LSM has a good performance in diagnosing advanced liver fibrosis compared to other serological examination. The negative predictive value (NPV) of LSM is 92% with cutoff 6.0 kPa in patient with normal ALT level and 7.5 kPa in patient with increased ALT level. The positive predictive value (PPV) of LSM is 98% with cutoff 9 kPa in patient with normal ALT level and 12 kPa in patient with increased ALT level.
[...]
4th Recommendation:
Invasive and non-invasive fibrosis evaluation are performed in patients > 30 years old with high viral load and increased ALT minimal serum level or in patients < 30 years old with high risk factor.'