Methodology to improve the accuracy of the non-invasive diagnosis of liver fibrosis in chronic hepatitis C
Prognosis and management of patients with chronic hepatitis C depends on the degree of liver fibrosis which is classically assessed by histological examination of a liver biopsy. However, liver biopsy is an invasive procedure and histological examination is impaired by sampling bias and fair reproductibility. Recently, new tests allow for a non-invasive evaluation of liver fibrosis : fibrosis blood tests and transient elastography (Fibroscan). Since December 2008, the French Health Authority has recommanded these tests as first-line exams for the assessment of fibrosis/cirrhosis in patients with chronic hepatitis C. However, these recommendations do not specify the practical use of these tests. In addition, the accuracy of non-invasive fibrosis tests has mainly been globally evaluated and the implement a methodology to improve the accuracy of the non-invasive diagnosis of liver fibrosis in hepatitis C. We developed several methodological concepts : fibrosis tests adapted to the diagnostic target, synchronous combinations of tests, association of intervals of reliable diagnosis. These new concepts were finally used to develop a new non-invasive classification of liver fibrosis, easy to use and very significantly more accurate than those actually used in clinical practice.