Noninvasive methods for the detection and diagnosis of hepatic diseases compared to the previous standard of care

Abstract

As the global burden of liver disease evolves, a need for noninvasive detection and diagnosis has emerged. For over fifty years biopsy has been the standard to which all other disease detection and confirmation methods have been compared. With the development of several noninvasive methods in the detection of liver disease, biopsy has come under scrutiny for its cost-effectiveness, reliability and safety. Serologic testing has proven useful but not specific overall for the determination of disease stages. Liver stiffness is a relatively new parameter used in the diagnosis and monitoring of hepatic disease. It is a quantifiable through the use of an ultrasound-based method of transient elastography using a tool Fibroscan. The implementation of transient elastography has changed the paradigm of liver disease diagnostics with a more cost effective, reproducible, reliable, and well-tolerated option.

While the hepatitis C virus is the primary cause of fibrosis and cirrhosis, numerous studies of the application of liver stiffness measurement to varying disease etiologies have broadened the scope of the method. Optimizing reliability criteria has been the focus of many studies to find a standard by which cirrhosis may be ruled out and fibrosis staging may be accomplished. Novel non-interferon based HCV therapies are altering the course of disease progression and may affect the need for continued development of noninvasive monitoring procedures. However, globally the impact of advanced liver disease is rising with an increase in mortality by fifty million cases per year from 1990-2010 indicating the continued relevance and need for widely applicable noninvasive procedures for both diagnosing hepatic disease and informing treatment options.