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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Vydáno v:JHEP reports Ročník 2; číslo 2; s. 100067
Hlavní autoři: Patel, Keyur, Sebastiani, Giada
Médium: Journal Article
Jazyk:angličtina
Vydáno: Netherlands Elsevier B.V 01.04.2020
Elsevier
Témata:
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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Abstract 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.
AbstractList SummaryThe 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.
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.
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.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.
ArticleNumber 100067
Author Patel, Keyur
Sebastiani, Giada
AuthorAffiliation 2 Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada
1 Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, ON, Canada
AuthorAffiliation_xml – name: 2 Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada
– name: 1 Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, ON, Canada
Author_xml – sequence: 1
  givenname: Keyur
  orcidid: 0000-0002-4677-3127
  surname: Patel
  fullname: Patel, Keyur
  email: keyur.patel@uhn.ca
  organization: Division of Gastroenterology, University Health Network Toronto, Toronto General Hospital, Toronto, ON, Canada
– sequence: 2
  givenname: Giada
  orcidid: 0000-0003-2655-8283
  surname: Sebastiani
  fullname: Sebastiani, Giada
  organization: Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada
BackLink https://www.ncbi.nlm.nih.gov/pubmed/32118201$$D View this record in MEDLINE/PubMed
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Issue 2
Keywords 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
Language English
License This is an open access article under the CC BY-NC-ND license.
2020 The Author(s).
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Snippet 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...
SummaryThe diagnostic assessment of liver injury is an important step in the management of patients with chronic liver disease (CLD). Although liver biopsy is...
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SubjectTerms Biomarkers
Elastography
Gastroenterology and Hepatology
Liver biopsy
Non-alcoholic fatty liver disease
Review
Viral hepatitis
Title Limitations of non-invasive tests for assessment of liver fibrosis
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