On the Issue of Liver Biopsy in Patients With Metabolically Associated Fatty Liver Disease

The aim of the work was to evaluate the possibility of replacing liver biopsy with other methods of examination in patients with metabolically associated fatty liver disease. All patients were examined according to a single diagnostic algorithm consisting of four stages: physical, laboratory, instrumental (using non-invasive bioimpedansometry, multiparametric ultrasound examination, dual-energy X-ray absorptiometry in the "Whole body" mode, computer and magnetic resonance imaging), histological (evaluation of liver micropreparations on the SAF scale). the patients were divided into three groups, taking into account the results of histological examination of biopsies on the SAF scale: group 1 – patients with hepatic steatosis without signs of inflammation, fibrosis (n = 56, 53.9%); group 2 – patients with steatohepatitis and clinically insignificant hepatic fibrosis F0-F1 (n = 30, 28.8%); group 3 – patients with steatohepatitis and clinically significant liver fibrosis F2-F3 (n = 16, 15.4%). the correlation of findings obtained by the histological examination of liver biopsies and the data of ultrasound quantitative liver steatometry is high – r = 0.95 (for liver steatosis S1), r = 0.84 (for liver steatosis S2), r = 0.91 (for liver steatosis S3); ultrasonic shear wave elastography – r = 0.84 (for clinically insignificant liver fibrosis F0-F1), r = 0.88 (for clinically significant liver fibrosis F2-F3). the data obtained using dual-energy X-ray absorptiometry in the "Whole Body" mode quantitatively reflect the state of the patient's metabolic status, they can be evaluated in dynamics due to low radiation load. Thus, the diagnostic complex consisting of assessing the level of hepatic transaminases, multiparametric ultrasound examination and dual-energy X-ray absorptiometry in the "Whole body" mode is optimal to examine the patients who have contraindications to liver biopsy or completely refuse to pass this study. in case of the patient's consent, absence of contraindications, as well as in the presence of a number of diffuse liver diseases, histological examination is recommended to identify and to assess in detail the dystrophic, inflammatory, sclerotic, regenerative processes.