Noninvasive diagnosis of fibrosis in chronic liver disease.

Laboratory tests for the noninvasive diagnosis of liver fibrosis were studied extensively in the past. However, no test is yet accepted to replace liver biopsy as the gold standard. The establishment of widely accepted semiquantitative histologic scoring systems for the grading and staging of chronic liver disease (e.g., Ishak, Metavir and Scheuer) was paralleled by a significant upturn of research in circulating markers of liver fibrosis. We are now experiencing the renaissance of standard clinical chemistry markers, which are assembled to multiparameter scores (e.g., aspartate aminotransferase-to-platelet ratio index, FibroTest, Forns' index). These scores still require comprehensive evaluation in comparison with histology. Better understanding of the pathophysiology of liver fibrosis provided new options regarding circulating markers of hepatic matrix metabolism (e.g., hyaluronic acid, laminin, matrix metalloproteinase-2, aminoterminal propeptide of procollagen type III and tissue inhibitors of metalloproteinases-1). Several promising studies have been published to date. Thus, a redefinition of the role of liver biopsy is expected in the foreseeable future.