Liver biopsy versus noninvasive methods--fibroscan and fibrotest in the diagnosis of non-alcoholic fatty liver disease: a review of the literature.

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in general population so it is impossible to perform liver biopsy in such a large number of patients to identify those with advanced fibrosis or non-alcoholic steatohepatitis. Liver biopsy has a potential sampling error, it is invasive and prone to complications, so it is no longer considered as mandatory as first line screening tools for chronic liver disease. The development of non-invasive biomarkers, FibroTest-ActiTest in 2001 and more recently FibroMax, as well as transient elastography (TE) has changed the management of chronic liver disease. The aim of this review is to summarize the advantages and limits of the available non-invasive biomarkers of liver fibrosis, in comparison with liver biopsy in NAFLD patients.