Can We Replace Liver Biopsy with Non-Invasive Procedures?

Liver fibrogenesis is the consequence of all hepatic lesions, regardless of etiology. Progressive scars, which are the response to constant liver injuries lead to cirrhosis, disorganize the normal liver architecture through fibrosis bands, parenchyma nodules and blood vessel distortions. For this reason, liver fibrosis is a central parameter which expresses the severity of liver diseases, regardless of etiology; it is a key element which predicts the evolution of liver diseases towards cirrhosis. Irrespective of the cirrhosis etiology, the clinical evolution is similar, towards major complications such as: portal hypertension and hepatocellular insufficiency. Due to these complications, cirrhosis is the seventh death cause within general mortality. Cirrhosis also encourages the development of hepatocellular carcinoma, an aggressive neoplasm which causes death in a few months in the absence of early diagnosis. That is why liver fibrosis is a major criterion in initiating the etiologic treatment of chronic liver diseases. A long time ago, liver fibrosis was deemed irreversible. This axioma has been discarded for quite some time; at present, fibrosis is considered to be a bidirectional dynamic phenomenon: fibrogenesis and fibrinolysis. Thus, it is possible to reshape the scar healing tissue. Due to this dynamic process, it is necessary to quantify fibrosis in order to set the therapeutic decision and especially to monitor the efficiency of anti fibrotic treatments. There are several methods to diagnose liver fibrosis: liver biopsy, serum biomarkers, breath tests and hepatic elastography. Liver biopsy is currently essential in diagnosis of inflammatory and metabolic liver diseases. It provides particularly invaluable informations for disease diagnosis and patient monitoring. The role of liver biopsy is still a controversial issue being an invasive method with wellknown risks and complications. Although liver biopsy is considered the golden standard for chronic liver diseases, it is worth mentioning that the histological tested fragment is however a small part of the liver, and the scar lesions, which are secondary to chronic inflammatory processes are unevenly distributed in the liver mass. Thus, liver biopsy is a method neither ideal nor sufficient to diagnose and determine the stage of liver fibrosis. In this context, a noninvasive method to assess liver fibrosis is more than welcome.