Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Abstract

It is estimated that 30% of the adult population in Japan is affected by nonalcoholic fatty liver disease (NAFLD). Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonography (US) and computed tomography (CT), but the sensitivity of these imaging techniques is low in cases of mild steatosis. Alanine aminotransferase levels may be normal in some of these patients, warranting the necessity to establish a set of parameters useful for detecting NAFLD, and the more severe form of the disease, nonalcoholic steatohepatitis (NASH). Although liver biopsy is currently the gold standard for diagnosing progressive NASH, it has many drawbacks, such as sampling error, cost, and risk of complications. Furthermore, it is not realistic to perform liver biopsies on all NAFLD patients. Diagnosis of NASH using various biomarkers, scoring systems and imaging methods, such as elastography, has recently been attempted. The NAFIC score, calculated from the levels of ferritin, fasting insulin, and type IV collagen 7S, is useful for the diagnosis of NASH, while the NAFLD fibrosis score and the FIB-4 index are useful for excluding NASH in cases of advanced fibrosis. This article reviews the limitations and merits of liver biopsy and noninvasive diagnostic tests in the diagnosis of NAFLD/NASH.

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

“…In future, improved non-invasive diagnostic and predictive models incorporating genomics could allow for the timely implementation of tailored therapeutic intervention, aimed at preventing disease onset as well as decreasing risk for cardiovascular-and liver-related mortality in patients with NAFLD [190] . A number of important limitations however continue to impede more widespread clinical application as part of routine patient management, including the need for external validation in large-scale prospective studies to confirm their reproducibility and robustness as well as applicability in the general population.…”

Fatty Liver Index (FLI) in Predicting Non-alcoholic Fatty Liver Disease (NAFLD)

“…In previous studies, the optimal cut-off point of FLI has been determined through applying ultrasound diagnosis. However, US has limitations such as low sensitivity in steatosis of less than 20% to 30% and dependency on the operator's judgment (15).…”

Efficacy of alogliptin in preventing non-alcoholic fatty liver disease progression in patients with type 2 diabetes

“…It is not clear whether the NAFIC score can be used to evaluate longitudinal outcome, which may have resulted in misclassification. Although liver biopsy is the gold standard for the diagnosis of NAFLD and assessment of disease progression, it is unrealistic to perform liver biopsies in all NAFLD patients with type 2 diabetes (20). Secondly, as this was a single arm study with a small number of patients and a short observation period for this type of study, to assessing the effect of significant potential confounding factors, such as calorie intake and exercise status, could not be performed.…”