Table 1

­Advantages and disadvantges of liver biopsy sampling, transient elastography and non-invasive markers of fibrosis 

Liver biopsyTE and non-invasive markers of fibrosis
Advantages

  • Definitive histological diagnosis*

  • Allows exclusion of other liver diseases*

  • Accurate fibrosis stage*

  • Additional assessment of necroinflammatory reaction and steatosis*

  • Validated score for HBV*

  • Helpful for delineation in intermediate disease*

  • Surplus tissue and slides stored for retrospective analysis*†

  • Tissue availability for routine HBV virological assessment (HBsAg staining)*†

  • Tissue availability for state-of-the-art virology (eg, cccDNA, integrated DNA)†

  • Tissue availability for state-of-the-art immunology research (eg, resident lymphocytes, HBV-specific T cells)†

  • Minimal risk*

  • Easy to perform*

  • Lower cost per test*

  • Painless, good patient acceptability

  • Immediate results available at ‘point of care’‡*

  • Easily repeated, allows longitudinal assessment*

Disadvantages

  • Invasive, bleeding risk (0.01% mortality)*

  • Pain-related morbidity, variable patient acceptability*

  • Sampling error*

  • Contraindicated in certain cases*

  • High cost per test*

  • Costly equipment‡*

  • Technical expertise required‡*

  • Unreliable in obese patients‡*

  • Skewed results with deranged LFTs‡*

  • Optimal cut-off levels not validated in HBV*

  • *Relevant for clinical purposes.

  • †Relevant for research purposes.

  • ‡Relevant to TE only.

  • cccDNA, covalently closed circular DNA; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen;  LFT, liver function test; TE,  transient elastography .