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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Volume 49, Issue 1 (Jan 2011)


Non-invasive assessment of liver fibrosis: it is time for laboratory medicine

Giada Sebastiani
  • Department of Digestive Diseases, Hepatology and Clinical Nutrition, Dell'Angelo Hospital, Venice, Venetian Institute of Molecular Medicine (VIMM), Padova, Italy
/ Konstantinos Gkouvatsos
  • Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Canada
/ Mario Plebani
  • Department of Laboratory Medicine, University-Hospital of Padova, and Leonardo Foundation, Abano Terme General Hospital, Padova, Italy
  • Email:
Published Online: 2010-10-20 | DOI: https://doi.org/10.1515/CCLM.2011.001


Chronic liver diseases (CLDs) represent a major cause of morbidity and mortality worldwide. In all etiologies of CLDs, staging of liver fibrosis is essential for both prognosis and management. Until a few years ago, liver biopsy was the only tool for the diagnosis of liver fibrosis in patients with CLDs. However, liver biopsy is an invasive and costly procedure. More recently, various serum biomarkers and laboratory tests have been proposed as surrogates of liver histology. Due to inadequate diagnostic accuracy or to lack of sufficient validation, guidelines still do not recommend them as a substitute for liver biopsy that is still considered the gold standard for the diagnosis of liver fibrosis. Notably, non-invasive serum biomarkers, when combined, may reduce by 50%–80% the number of liver biopsies needed for correctly classifying hepatic fibrosis. However, liver biopsy cannot be avoided completely, but should be used in those cases in which non-invasive methods show poor accuracy. In this view, serum biomarkers and liver biopsy represent a union between laboratory medicine and hepatology.

Keywords: combination algorithms; diagnostic performance; liver biopsy; liver fibrosis; non-invasive biomarkers; staging

About the article

Corresponding author: Mario Plebani, Department of Laboratory Medicine, University-Hospital, Via Giustiniani, 2, 35128 Padova, Italy Phone: +39 049 8212792, Fax: +39 049 663240

Received: 2010-03-10

Accepted: 2010-05-25

Published Online: 2010-10-20

Published in Print: 2011-01-01

Citation Information: Clinical Chemistry and Laboratory Medicine, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.001. Export Citation

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