The presence and degree of hepatic fibrosis is crucial in order to make therapeutic decisionsand predict clinical outcomes. Currently, the place of liver biopsy as the standard of referencefor assessing liver fibrosis has been challenged by the increasing awareness of a number ofdrawbacks related to its use (invasiveness, sampling error, inter-/intraobserver variability). Inparallel with this, noninvasive assessment of liver fibrosis has experienced explosive growthin recent years and a wide spectrum of noninvasive methods ranging from serum assays toimaging techniques have been developed. Some are validated methods, such as the Fibrotest/Fibrosure and transient elastography in Europe, and are gaining a growing role in routine clinicalpractice, especially in chronic hepatitis C. Large-scale validation is awaited in the settingof other chronic liver diseases. However, noninvasive tests used to detect significant fibrosisand cirrhosis, the two major clinical endpoints, are not yet at a level of performance suitablefor routine diagnostic tests, and there is still no perfect surrogate or method able to completelyreplace an optimal liver biopsy. This article aims to review current noninvasive tests for theassessment of liver fibrosis and the perspectives for their rational use in clinical practice.Keywords liver fibrosis, non-invasive, transient elastography, serum biomarkers, liver biopsyAnn Gastroenterol 2012; 25 (2): 218-231
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