Diagnosis of hepatic fibrosis and cirrhosis

Liver biopsy is the gold standard in the diagnosis of liver diseases, despite its limitations, such as sampling error and its invasive nature. Given the increasing prevalence ofhepatic fibrosis and cirrhosis, new non-invasive methods are being developed as a substitute for liver biopsy. Transient elastography (Fibroscan), which measures the stiffness of the liver by means of ultrasound as a measure of fibrosis and cirrhosis, is simple to perform and the inter- and intra-observer variability is small. The accuracy, in relation to liver biopsy, is high in discriminating between cirrhosis and fibrosis, but lower for discriminating between the different stages offibrosis. The Fibrotest is the most investigated combination of serum markers for fibrosis. Its accuracy is lower than that ofa liver biopsy. In the years to come, more research by various independent research groups is needed with the Fibroscan method and the combination of serum markers in different groups of patients and with standardised cut-off points; these must be compared with liver biopsies of sufficient length. In this way, the value of these non-invasive methods can be evaluated. A possible future role for serum markers is to combine them with the Fibroscan, whereby a discrepancy between the different tests could be an indication for a liver biopsy.