Biopsies are still better for determining the extent of liver damage in hepatitis C patients despite recent studies showing the effectiveness of blood tests.
Writing in the May issue of Hepatology, Dr. Nezam H. Afdhal, of Beth Israel Deaconess Medical Center in Boston, said the ability to determine the degree of liver injury or to predict the risk of liver disease progression for the patient still requires an "old-fashioned" liver biopsy.
Clinicians use biopsies to determine the need for therapy. Afdhal said the complexity and side effects of interferon-based therapies for the disease have increased the role of the liver biopsy in the decision on whether to treat a patient.
Patients with significant liver fibrosis or moderate inflammation are all considered suitable for therapy, whereas patients with milder disease are often not as aggressively offered treatment.
However, as newer, better-tolerated and more effective therapies are developed, Afdhal said the need to biopsy all hepatitis C patients to gauge the severity of their condition could become redundant.
"Therefore, the development of noninvasive tests that can differentiate between patients with mild disease versus those with more significant fibrosis could have a widespread clinical utility in managing hepatitis C patients in the future," said Afdhal.
Afdhal said it could be argued that blood tests can categorize almost a third of patients into those with mild liver disease and use this information for decision analysis without a liver biopsy.
"Unfortunately, there is somewhat of a rush to commercialize these so-called tests of liver fibrosis without rigorous scientific validation," Afdhal observed.
Other sources: Hepatology