Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning global health concern. In the subset of NAFLD patients with non-alcoholic steatohepatitis (NASH), the presence of significant fibrosis at index assessment is associated with poor prognosis and increased mortality. Hence, there is a growing need to accurately assess and stage fibrosis. Liver biopsy, the current gold standard, has limitations with sampling error and is invasive, with associated inherent risk. This has led to a host of non-invasive means of assessing fibrosis, which has garnered relevance in a disease that requires serial assessment of fibrosis longitudinally over time. This review discusses, comprehensively, the various tools available to the clinician for the assessment of fibrosis, including the various scoring systems used in liver biopsy, the non-invasive means of serum biomarkers, such as the highly-validated NAFLD fibrosis score, and the imaging-based modalities, such as transient elastography and magnetic resonance elastography.

Simple Noninvasive Scores Are Clinically Useful to Exclude, Not Predict, Advanced Fibrosis: A Study in Turkish Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease

“…In this regard, it should be noted that the diagnostic performances of compound surrogates may be influenced by potential confounders (e.g., patient age, prevalence of different fibrosis stages, and different NAFLD disease spectrum). [12][13][14][15][16][17][18][19] These limitations notwithstanding, our results indicate that the main clinical utility of FIB-4 and NFS in patients with NAFLD lies in their ability to exclude, rather than identify, advanced fibrosis. Specifically, the routine application of FIB-4, a simple compound surrogate based on four parameters, is expected to reduce the number of liver biopsy by nearly 70%.…”

Proteomic screening of plasma identifies potential noninvasive biomarkers associated with significant/advanced fibrosis in patients with nonalcoholic fatty liver disease

“…methods [2][3][4][5][6][7][8][9][10][11][12], including imaging modalities [13][14][15][16][17], biomarkers [18][19][20][21][22][23][24][25][26], and artificial intelligence algorithms [27][28][29][30][31][32].…”

Pro: Noninvasive Imaging Has Replaced Biopsy as the Gold Standard in the Evaluation of Nonalcoholic Fatty Liver Disease

“…3,4 In the United States, the number of individuals with NASH is estimated to be more than 11 million, and our ability to delineate which patients with NAFLD have NASH remains poor at present. The long-standing use of liver enzymes to differentiate these different entities has been debunked and proved inadequate, [4][5][6][7] and despite extensive work in the research realm, no other straightforward serological tests or panels have shown results convincing enough to usurp the previous gold standard. 6,7 The outdated dogma of liver biopsy being the gold standard for identifying those at risk among these millions of patients would mean extrapolating to this population the known severe complication rate of 1.1% 8 and mortality rate of 0.3%.…”

“…The long-standing use of liver enzymes to differentiate these different entities has been debunked and proved inadequate, [4][5][6][7] and despite extensive work in the research realm, no other straightforward serological tests or panels have shown results convincing enough to usurp the previous gold standard. 6,7 The outdated dogma of liver biopsy being the gold standard for identifying those at risk among these millions of patients would mean extrapolating to this population the known severe complication rate of 1.1% 8 and mortality rate of 0.3%. 9 If we are to appropriately identify the NAFLD population most at risk for progression to cirrhosis by means of biopsy, it corresponds to daunting figures of morbidity and death.…”