Limitations of non-invasive tests for assessment of liver fibrosis

The diagnostic assessment of liver injury is an important step in the management of patients with chronic liver disease (CLD). Although liver biopsy is the reference standard for the assessment of necroinflammation and fibrosis, the inherent limitations of an invasive procedure, and need for repeat...

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Veröffentlicht in:	JHEP reports Jg. 2; H. 2; S. 100067
Hauptverfasser:	Patel, Keyur, Sebastiani, Giada
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Netherlands Elsevier B.V 01.04.2020 Elsevier
Schlagworte:	Biomarkers Elastography Gastroenterology and Hepatology Liver biopsy Non-alcoholic fatty liver disease Review Viral hepatitis MRE NAFLD ALT FLIP SVR AUC IFN Viral hepatitis NFS AGA Elastography US BMI Liver biopsy AST DAA MR LSM HCC CAP CPA VCTE Biomarkers APRI CLD FIB-4 Non-alcoholic fatty liver disease CHB ELF NITs CHC magnetic resonance alanine aminotransferase non-invasive tests chronic liver disease hepatocellular carcinoma chronic hepatitis B body mass index chronic hepatitis C controlled attenuation parameter NAFLD fibrosis score enhanced liver fibrosis fibrosis-4 American Gastroenterology Association magnetic resonance elastography sustained virologic response collagen proportionate area vibration-controlled transient elastography fatty liver inhibition of progression area under the curve interferon ultrasound aspartate aminotransferase direct-acting antiviral liver stiffness measure AST-platelet ratio index AUC, area under the curve CLD, chronic liver disease CHB, chronic hepatitis B LSM, liver stiffness measure MR, magnetic resonance BMI, body mass index FIB-4, fibrosis-4 APRI, AST-platelet ratio index NAFLD, non-alcoholic fatty liver disease CHC, chronic hepatitis C VCTE, vibration-controlled transient elastography ALT, alanine aminotransferase IFN, interferon FLIP, fatty liver inhibition of progression NFS, NAFLD fibrosis score CAP, controlled attenuation parameter AGA, American Gastroenterology Association MRE, magnetic resonance elastography DAA, direct-acting antiviral ELF, enhanced liver fibrosis NITs, non-invasive tests HCC, hepatocellular carcinoma SVR, sustained virologic response AST, aspartate aminotransferase CPA, collagen proportionate area US, ultrasound
ISSN:	2589-5559, 2589-5559
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Zusammenfassung:	The diagnostic assessment of liver injury is an important step in the management of patients with chronic liver disease (CLD). Although liver biopsy is the reference standard for the assessment of necroinflammation and fibrosis, the inherent limitations of an invasive procedure, and need for repeat sampling, have led to the development of several non-invasive tests (NITs) as alternatives to liver biopsy. Such non-invasive approaches mostly include biological (serum biomarker algorithms) or physical (imaging assessment of tissue stiffness) assessments. However, currently available NITs have several limitations, such as variability, inadequate accuracy and risk factors for error, while the development of a newer generation of biomarkers for fibrosis may be limited by the sampling error inherent to the reference standard. Many of the current NITs were initially developed to diagnose significant fibrosis in chronic hepatitis C, subsequently refined for the diagnosis of advanced fibrosis in patients with non-alcoholic fatty liver disease, and further adapted for prognostication in CLD. An important consideration is that despite their increased use in clinical practice, these NITs were not designed to reflect the dynamic process of fibrogenesis, differentiate between adjacent disease stages, diagnose non-alcoholic steatohepatitis, or follow longitudinal changes in fibrosis or disease activity caused by natural history or therapeutic intervention. Understanding the strengths and limitations of these NITs will allow for more judicious interpretation in the clinical context, where NITs should be viewed as complementary to, rather than as a replacement for, liver biopsy.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	2589-5559 2589-5559
DOI:	10.1016/j.jhepr.2020.100067