Noninvasive assessment of liver fibrosis: key messages for clinicians

Liver biopsy LB enables not only the evaluation of hepatic fibrosis but also provides useful information on numerous processes such as inflammation, necrosis, or steatosis.It also enables to identify and quantify iron and copper within the liver parenchyma, allowing to identify suspected or unexpected cofactors and comorbidities.7 To investigate the activity grade of inflammation and to stage the amount and type of liver fibrosis, many scoring systems have been proposed. Among those specifically designed for chronicIntroduction Chronic liver diseases (CLDs), particularly those related to hepatitis C and B viruses and to alcoholic and nonalcoholic fatty liver (nonalcoholic fatty liver disease -NAFLD; nonalcoholic steatohepatitis -NASH), are diffuse worldwide.1,2 The natural history of CLD in the long term varies widely in relation to host and causal factors.Since prognosis and management of CLD are strongly influenced by the degree of liver fibrosis, the precise definition of fibrosis stage is crucial to assess the risk of disease progression toward cirrhosis and its complications, and to prompt immediate treatment.3,4 The different causes of CLD have a common histopathological pathway, the formation and accumulation of fibrosis that leads to the distortion of the hepatic architecture and the subsequent evolution to cirrhosis.The development of liver fibrosis starts from the minimal degree limited to the portal tracts followed by more extensive fibrosis with septa forming bridges between two portal tracts or portal tracts and central veins.With time, this process progresses to widespread fibrosis and nodule formation.