COMMENTARY

Noninvasive Diagnosis of Liver Fibrosis in Patients With Chronic Hepatitis C

Laurent Castera, MD; Jean-Michel Pawlotsky, MD

Disclosures

November 09, 2005

In This Article

Introduction

The prognosis and management of chronic liver diseases greatly depends on the degree and progression of liver fibrosis. Until recently, liver biopsy was the only way to evaluate fibrosis in the liver.[1] However, liver biopsy is an invasive and painful procedure,[2,3] with rare but potentially life-threatening complications.[1] Thus, many patients are reluctant to undergo liver biopsies, and patients with chronic hepatitis C may be discouraged from starting therapy for this reason. The accuracy of liver biopsy in assessing fibrosis has also been questioned in relation to sampling errors and intra- and interobserver variability that may lead to over- or understaging.[4,5,6,7,8,9] Even when an experienced physician performs liver biopsy and an expert pathologist reads and interprets the findings, up to a 20% error rate in disease staging has been reported.[10] In a recent study, Bedossa and colleagues,[7] using the METAVIR scoring system, showed that only 65% of 15-mm biopsies (the currently recommended size) and 75% of 25-mm biopsies were correctly staged. Regev and colleagues[5] found a difference of at least 1 fibrosis stage between the right and left lobes in 33% of 124 patients, whereas Siddique and colleagues[8] observed a difference of at least 1 fibrosis stage between 2 specimens of at least 15 mm taken at the same puncture site in 45% of patients. Finally, Colloredo and colleagues[6] reported a tendency to underscore fibrosis as the size of the biopsy sample diminished. These findings emphasize the need for accurate noninvasive methods to measure the degree of liver fibrosis. Ideally, a noninvasive marker of liver fibrosis should be liver-specific, easy to perform, reliable, and inexpensive. In addition, it should be accurate not only for the grading of fibrosis, but also for the monitoring of disease progression and the efficacy of antiviral therapy. To date, almost all of the data regarding the use of noninvasive markers of fibrosis have been generated in patients with chronic hepatitis C, and these data need to be extended to other liver diseases.

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