Service d'Hépato-Gastroenterologie, Hôpital Saint-André, C.H.U. Bordeaux, Service d'Hépato-Gastroenterologie, Hôpital Haut Lévêque, C.H.U. Bordeaux, Avenue Magellan, 33604 Pessac
Quantifying liver fibrosis in chronic hepatitis C is of critical importance not only for prognosis but also for antiviral treatment indication. Two end points are clinically relevant: detection of significant fibrosis (indication for antiviral treatment); detection of cirrhosis (screening for eosphageal varices and hepatocellular carcinoma). Until recently, liver biopsy was considered the reference method for the evaluation of liver fibrosis. Limitations of liver biopsy (invasiveness, sampling error and inter-observer variability) have led to the development of non invasive methods. Currently available methods rely on two different approaches: a “biological” approach based on serum biomarkers of fibrosis; a “physical” approach based on the measurement of liver stiffness using transient elastography. These methods can be considered validated in chronic hepatitis C and are already widely used in clinical practice as first line assessment of liver fibrosis. This review is aimed at discussing the advantages and limits of non invasive methods and liver biopsy and the perspectives for their rationale use in clinical practice in the management of patients with chronic hepatitis C in 2010.