Transient elastography and serum biomarkers: two-step screening methods for liver fibrosis in non-alcoholic fatty liver disease before liver biopsy

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease and nowadays it is recognized as one of main leading cause of liver fibrosis worldwide. Because of the high risk to develop cirrhosis and hepatocellular carcinoma, the early assessment of liver fibrosis is an important part of the management of NAFLD patients. To date, histological evaluation of liver biopsy represents the cornerstone for staging and grading liver fibrosis. However, due to the several drawbacks of this approach, during the last decade clinicians and researchers are dedicating their efforts to the identification of novel, safe and effective non-invasive tools to assess liver fibrosis. As due to their accuracy degree, transient elastography (TE) and serum biomarkers seem to be able to replace liver biopsy to determine at least the presence of significant liver fibrosis. The combination of these tools may greatly enhance their diagnostic power. Nevertheless, investigations of new imaging techniques and the molecular pathogenesis of NAFLD are necessary to develop reliable non-invasive alternative approaches to liver biopsy. Here, the authors discuss the salient aspects of diagnostic performance of TE and serum biomarkers available for detecting hepatic fibrosis in NAFLD and provide suggestions as to how these non-invasive techniques can be incorporated into diagnostic management of patients affected by this disease.