Klinische Bedeutung – Sinn und Unsinn – der Leberbiopsie bei NAFLD

Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum ranging from bland non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular cancer. Whereas “pure” NAFL rarely results in progressive liver disease, NASH can progress to liver cirrhosis in up to 25% of NASH patients. NAFL and NASH are both associated with an increased cardiovascular mortality, which represents the most important prognosis-limiting factor in both conditions. Diagnosis of NAFLD is based on clinical, biochemical, and sonographic findings. Liver biopsy is required for histologic distinction between NAFL and NASH. Because the therapeutic options for NASH are currently limited, liver biopsy has a rather limited value in the daily clinical management of NAFLD. Non-invasive laboratory and imaging methods (such as ultrasound elastography) may become increasingly important in the future.