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World J Hepatol. Nov 18, 2015; 7(26): 2664-2675
Published online Nov 18, 2015. doi: 10.4254/wjh.v7.i26.2664
Challenges of liver cancer: Future emerging tools in imaging and urinary biomarkers
Francesca M Trovato, Joshua M Tognarelli, Mary ME Crossey, Daniela Catalano, Simon D Taylor-Robinson, Guglielmo M Trovato
Francesca M Trovato, Daniela Catalano, Guglielmo M Trovato, Dipartimento di Medicina Clinica e Sperimentale, Scuola di Medicina, Università di Catania, 95100 Catania, Italy
Joshua M Tognarelli, Mary ME Crossey, Simon D Taylor-Robinson, Department of Medicine, Imperial College London, St Mary’s Campus, London W2 1NY, United Kingdom
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: No relevant or potential conflict of interest is present for any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guglielmo M Trovato, MD, Dipartimento di Medicina Clinica e Sperimentale, Scuola di Medicina, Università di Catania, Via Santa Sofia 78, 95100 Catania, Italy. guglielmotrovato@unict.it
Telephone: +39-09-5371533
Received: June 22, 2015
Peer-review started: June 22, 2015
First decision: August 25, 2015
Revised: September 24, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: November 18, 2015
Processing time: 149 Days and 3 Hours
Abstract

Chronic liver disease has become a global health problem as a result of the increasing incidence of viral hepatitis, obesity and alcohol misuse. Over the past three decades, in the United Kingdom alone, deaths from chronic liver disease have increased both in men and in women. Currently, 2.5% of deaths worldwide are attributed to liver disease and projected figures suggest a doubling in hospitalisation and associated mortality by 2020. Chronic liver diseases vary for clinical manifestations and natural history, with some individuals having relatively indolent disease and others with a rapidly progressive course. About 30% of patients affected by hepatitis C has a progressive disease and develop cirrhosis over a 20 years period from the infection, usually 5-10 years after initial medical presentation. The aim of the current therapeutic strategies is preventing the progression from hepatitis to fibrosis and subsequently, cirrhosis. Hepatic steatosis is a risk factor for chronic liver disease and is affecting about the half of patients who abuse alcohol. Moreover non-alcoholic fatty liver disease is part of the metabolic syndrome, associated with obesity, hypertension, type II diabetes mellitus and dyslipidaemia, and a subgroup of patients develops non-alcoholic steatohepatitis and fibrosis with subsequent cirrhosis. The strengths and pitfalls of liver biopsy are discussed and a variety of new techniques to assess liver damage from transient elastography to experimental techniques, such as in vitro urinary nuclear magnetic resonance spectroscopy. Some of the techniques and tests described are already suitable for more widespread clinical application, as is the case with ultrasound-based liver diagnostics, but others, such as urinary metabonomics, requires a period of critical evaluation or development to take them from the research arena to clinical practice.

Keywords: Virus hepatitis; Liver cancer; Ultrasound; Fibrosis; Urinary biomarkers

Core tip: There is an increasing need for non-invasive assessment of liver disease. New techniques to assess liver damage from transient elastography to experimental techniques, such as in vitro urinary nuclear magnetic resonance spectroscopy are currently investigated. The guidelines of sustainability in countries with limited resources, facilities and low financial income can be seen as an opportunity for addressing research toward low-cost diagnostics and for driving clinical practice toward more streamlined technology, with ultimate benefits for the populations of poorer countries around the world. In this perspective, urinary biomarkers of liver cancer and ultrasound imaging are two complementary models.