Noninvasive Test Instead of Biopsy

Photo: Hand grabs surgical instruments from a table

Cutting is not necessary to
diagnose advanced liver fibrosis;
© Picture Desk

Liver biopsy is limited by invasiveness, risk of complications, patient discomfort and the availability of expertise. Liver stiffness measurement (LSM) has been shown to be a reliable tool to detect liver cirrhosis, and transient elastography is a rapid, non-invasive and reproducible new technique being employed to measure liver stiffness.

In the study, the scientists evaluated the accuracy of LSM to detect severe liver fibrosis in 133 patients suffering from chronic liver diseases. The research team recruited adult patients with chronic liver diseases who were clinically indicated for liver biopsy examination in a twelve-month window. Chronic drinkers or those with decompensated liver disease, complications of liver cirrhosis, previous liver surgery or liver transplantation were excluded. LSM was performed within four weeks of the liver biopsy examination.

Study results showed that LSM is most accurate when diagnosing liver disease in patients with advanced, or pericellular, fibrosis, revealing a high correlation (r=0.43) between LSM and pericellular disease. In addition, the correlation of LSM and pericellular fibrosis was stronger in patients with severe fibrosis than in those with mild disease. Though not statistically significant, LSM also provided a better prediction of cirrhosis than did bridging fibrosis, which is an earlier stage of liver disease.

Higher LSM also was associated with higher serum alanine transaminase (ALT) levels, another marker of liver disease. Patients with higher ALT levels tended to have higher LSM than those with lower ALT levels at the same stage of liver fibrosis. This finding lead the research team to conclude that transient elastography may overestimate liver fibrosis when ALT is elevated.; Source: American Gastroenterological Association