Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11567
Peer-review started: May 7, 2015
First decision: June 26, 2015
Revised: July 23, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: November 7, 2015
The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this “gold-standard” is imperfect; even according to its proponents, it is only “the best” among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.
Core tip: Liver fibrosis (leading to liver cirrhosis), and not inflammation and cytolysis, is the main cause of liver disease-associated morbidity and mortality. During the last 20 years, it has become evident, even to its proponents that liver biopsy, is no longer the “gold-standard”. At most, it is the old standard. Non-invasive diagnostic scores, formulae, and imaging modalities, all of which can be repeated as often as required, are cheaper, better tolerated, safer, and more acceptable to the patient than liver biopsy. Although their accuracy is still controversial, early evidence indicates that they might be at least as good as liver biopsy.