Abstract and Introduction
Abstract
Background Accurate determination of the presence and degree of liver fibrosis is essential for prognosis and for planning treatment of patients with chronic hepatitis C virus (HCV). Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy.
Aim To perform a review of these non-invasive measures and their ability to replace biopsy for assessing hepatic fibrosis in patients with chronic HCV.
Methods A systematic review of PUBMED and EMBASE was performed through 2008 using the following search terms: HCV, liver, elastography, hepatitis, Fibroscan, SPECT, noninvasive liver fibrosis, ultrasonography, Doppler, MRI, Fibrotest, Fibrosure, Actitest, APRI, Forns and breath tests, alone or in combination.
Results We identified 151 studies: 87 using biochemical, 57 imaging and seven breath tests either alone or in combination.
Conclusions Great strides are being made in the development of accurate non-invasive methods for determination of fibrosis. Although no single non-invasive test or model developed to date can match that information obtained from actual histology (i.e. inflammation, fibrosis, steatosis), combinations of two modalities of non-invasive methods can reliably differentiate between minimal and significant fibrosis, and thereby avoid liver biopsy in a significant percentage of patients.
Introduction
Accurate determination of the presence and degree of liver fibrosis is essential for predicting prognosis and for planning treatment of patients with chronic hepatitis C virus (HCV) infection. Percutaneous liver biopsy is considered the gold standard for assessing hepatic fibrosis. This method, however, is invasive and carries a significant rate of complications, ranging from 1% to 5%, and risk of mortality ranging from 1 in 1000 to 1 in 10 000. In addition, biopsy is subject to sampling error and inter-observer variability. In the last 10 years, non-invasive methods of assessing liver fibrosis utilizing laboratory methods and imaging (Table 1) have been developed to reduce the need for biopsy. Because of confusing literature, we performed a systematic review of these non-invasive measures and their ability to replace biopsy for assessing hepatic fibrosis and inflammation in patients with chronic HCV in an attempt to put these studies into perspective.