Liver biopsy versus noninvasive testing in chronic hepatitis C: Where do we stand in 2008?

2008 Current Hepatitis Reports 7, 2 (51-59)

Abstract The liver biopsy has historically been the diagnostic gold standard, albeit imperfect, for establishing the degree of inflammation and fibrosis in patients with chronic hepatitis C (CHC). However, this procedure is associated with the risk of complications, sampling variability, intra-and interobserver interpretation variability, and high cost. Recently, there has been significant interest in developing noninvasive modalities to accurately assess disease severity in CHC. Numerous scoring models have been proposed and validated, each with variable results depending on the study population assessed, the degree of significant fibrosis, and the type of liver biopsy scoring system and fibrosis markers used, making interpretation of the literature potentially confusing. Individual scoring algorithms have been shown to accurately distinguish F0–F1 versus F2–F4 fibrosis in about 50% of cases, with the rate improving somewhat for distinguishing more advanced fibrosis. Combination testing may further enhance the diagnostic accuracy of the tests. Imaging studies such as FibroScan (Echosens, Paris, France) and magnetic resonance elastography hold significant promise, but caution should be used when considering this modality in the setting of obesity, nonalcoholic fatty liver disease, ascites, or acute hepatitis.