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Transient elastography in chronic viral hepatitis: a critical appraisal
  1. Ana-Carolina Cardoso1,
  2. Roberto J Carvalho-Filho2,
  3. Patrick Marcellin1
  1. 1Service d'Hépatologie et INSERM U773-CRB3, Hôpital Beaujon, APHP, University of Paris 7, Clichy, France
  2. 2Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Professor Patrick Marcellin, 100 Boulevard du Gal-Leclerc, Service d'Hépatologie, Hôpital Beaujon, Pavillion Abrami, 92110 Clichy, France; patrick.marcellin{at}bjn.aphp.fr

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Even with all the heated discussion about the value of liver biopsy, it remains the gold standard method for the assessment of liver fibrosis and the severity of chronic liver diseases.1 Histological analysis of liver tissue still provides invaluable information about three key issues for the management of patients with liver diseases: diagnosis, prognosis and therapeutic decisions. In the context of chronic infection with hepatitis C virus (HCV) or hepatitis B virus (HBV), evaluation of the stage of liver fibrosis is of major importance. Additional information can also be provided, such as the pattern of liver fibrosis, grading of necroinflammatory activity and the presence of steatosis and hepatic iron overload. These and other histological findings are highly relevant in clinical practice, because they not only allow the clinician to infer on the dynamics of fibrogenesis (whether lesions are ancient or progressive), but also permit the identification of associated liver diseases that can potentially alter the natural history of chronic viral hepatitis and impair the efficacy of therapy.

Nevertheless, liver biopsy is a costly and invasive technique with associated mortality and morbidity, well documented in both retrospective and prospective studies.2 3 A typical biopsy fragment represents only 1/50 000 of the organ and most chronic liver diseases exhibit a heterogeneous distribution of hepatic fibrosis. Therefore, histopathological analysis of liver tissue is susceptible to variability in interpretation, being significantly influenced by the quality of the fragment (adequate length and number of portal tracts) and by the expertise of the pathologist.4 5

In a world with an imperfect gold standard model, several non-invasive approaches have been proposed to estimate liver fibrosis in patients with liver diseases, …

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