Would the Physicians Eventually Obsolete the Liver Biopsy for the Assessment of Liver Fibrosis?

In recent article which is published in your journal Crisan D et al. (1) has been reported an interesting article about noninvasive assessment of liver fibrosis. They evaluated six serum marker panels (APRI, Forns, Fib-4, Hepascore, Fibro Test, Fibro meter) and transient elas-tography (TE) alone or in combination, for prediction of liver fibrosis stages in 446 chronic hepatitis C (CHC) patients. In addition they evaluated whether the combination of serum panels with TE could increase the diagnostic accuracy of liver fibrosis assessment or not. The authors concluded that combination of some of previously mentioned serum marker panels with TE, increases the diagnostic accuracy of non-invasive methods for the assessment of liver fibrosis stage. Studies such as previously mentioned article are very important, because the findings would help us to improve our knowledge about the staging of liver fibrosis. Nowadays the list of serum marker algorithms for assessment of liver fibrosis is increasing. According to the literature, there are various algorithms for noninvasive assessment of liver fibrosis in patients with viral chronic hepatitis C and the most well-known of them are: Fibro test, Forns, APRI, FIB-4, Hepas-core, Fibro meter, ELF, Fibro scan (2-8). Certainly in the future, new serum marker panels will add to this list. In addition some techniques such as transient elastography will help physicians in the exact estimation of the liver fibrosis stage (9). In Most of the published studies these serum markers panels were used in order to assess liver fibrosis in patients with chronic hepatitis, particularly chronic hepatitis C. simultaneously It is recommended that combination of these markers done in other types of liver fibrosis diseases including chronic hepatitis B, autoimmune hepatitis, non-alcoholic fatty liver disease and the others. Now in calculation of the severity of liver fibrosis, liver biopsy stayed the gold standard; however the acceptability of this method by patients is low. In addition this method has some major limitation and its limitations made it a non-favorable method (6). But it seems that the major benefit of liver biopsy is its applicability for assessment of liver fibrosis stages in all liver fibrosis diseases. In addition by this method, physicians are able to determine the grade of necro inflammatory injury of liver. In clinic, we should able to diagnose liver fibrosis stage and also grade of liver necro inflammatory injuries (because of