A Clinical and Histopathologic Perspective on Evolving Noninvasive and Invasive Alternatives for Liver Biopsy

摘要: Noninvasive or minimally invasive alternatives are proposed as substitutes for liver biopsy and include clinical indices, cross-sectional imaging, serum biomarkers, stiffness measurement, portal pressure measurement. Most to assess one aspect of disease translate this into a numeric score. Overlap between categories may limit applications. Liver provides information about numerous variables: tissue architectural changes; necroinflammatory injury; fibrotic stage; alterations parenchyma bile duct epithelium; accumulation fat, copper, iron; molecular genetic changes. identify multiple etiologies. A single score cannot be substitute complete histologic assessment. However, within defined contexts, noninvasive assessment is an attractive alternative many patients given the ease, avoidance risk from procedures, validated contribution management. Serum biomarkers become indispensable in longitudinal studies document outcome treatments. The accuracy more reliable techniques typically around 80%. Neither nor any option represents absolute disease. Biopsy not mutually exclusive options. require clear understanding significance limitations each investigation. This places responsibility on clinician consider fully results investigative options used diagnostic prognostic context individual patient, choose critically most appropriate investigations patient's needs.