Smith JO, Sterling RK
Systematic review: Non-invasive methods of fibrosis analysis in chronic hepatitis C. [JOURNAL ARTICLE]
Aliment Pharmacol Ther 2009 Jun 10.
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: Because of confusing literature, we performed a review of these noninvasive measures and their ability to replace biopsy for assessing hepatic fibrosis in patients with chronic HCV in an attempt to put these studies into perspective.
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 7 breath tests either alone or in combination.
Conclusions: Great strides are being made in the development of accurate non-invasive methods for determination fibrosis. Although no single non-invasive 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.
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