Non-Invasive Alternatives to Liver Biopsy


To measure degree of liver inflammation and scarring, several non-invasive alternatives to biopsy have been developed. These include mathematical analysis of blood tests such as APRI and FibroTest [FibroSure in the USA]); and a new technology, transient elastography (FibroScan). Most experts recommend using a combination of two or  all three of the tests, though some say FibroScan alone is sufficient. The tests all give a score which correlates with the Stage 1-4 scoring commonly used with biopsy.

NOTE: Abdominal ULTRASOUND is a useful screening test for cancerous tumours.  It can detect even very small tumours. However, it is not useful for determining liver scarring or inflammation. When used with DOPPLER technology, it takes longer (45 minutes or so), but can examine changes in the portal vein and hepatic artery. When used on a regular basis over time, changes are more likely to be detected. Therefore it is often recommended once or twice per year in patients with advanced liver disease.

APRI (AST to Platelet Ratio Index) is the simplest and cheapest non-invasive test. Anyone with results from a current AST and Platelet count can compute their own APRI score. MORE APRI INFO here.

FIBROTEST (FIBROSURE in USA) – and related “ActiTest” – are far more sophisticated and somewhat more expensive than the APRI. MORE FIBROTEST/FIBROSURE INFO here.

FIBROSCAN (also known as transient elastography, a technology developed by Echosens™ of Paris, France) poses the greatest competition to biopsy as it is non-invasive, less expensive, and (arguably) equally accurate in measuring degree of liver inflammation and fibrosis, particularly in the higher end of the Metavir Fibrosis scale (Stages 3 and 4). MORE FIBROSCAN INFO here.