Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update

2008 Hepatology International 2, 3 (263-283)

Role of non-invasive examinations in evaluating severity of hepatic fibrosis. [...] Recently, non-invasive examinations to evaluate the severity of hepatic fibrosis have been introduced and are known to assess the severity of liver fibrosis accurately. There are several reports that non-invasive methods such as liver stiffness measurement (LSM) by transient elastography (TE, FibroScan) and other serologic tests could be used as an alternative to liver biopsy in patients with chronic hepatitis B. LSM was found to have the best performance in diagnosing advanced fibrosis (METAVIR ? 3) than any other serum test formulae, with an NPV of 92% for a cut-off of ? 6.0 kPa for patients with normal ALT and ? 7.5 kPa for those with elevated ALT and a PPV of 98% for a cut-off of ? 9 kPa for patients with normal ALT and ? 12 kPa for patients with elevated ALT. However, neither biomarkers nor biopsy alone are sufficient to make a definitive decision in a given patient, and all the clinical and biological data must be taken into account. These noninvasive tests cannot replace liver biopsy completely and should be used as a complementary tool in the management of patients with chronic hepatitis B.

Pubmed : 19669255