Index of 5 Blood Tests Used to Predict Liver Fibrosis Instead of Biopsy
     Article written by French Hepatitis research group appearing in Lancet April 7, 2001

" Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study " (in PDF format)

In this Lancet article, the authors report on their research of an index of 5 blood tests that could replace using a liver biopsy. The research is in my opinion very preliminary and I have concerns about this inex replacing a biopsy, but it is important research. The authors report that "with the best index, a high negative predictive value (100% certainty of absence of F2, F3, or F4) was obtained for scores ranging from zero to 0.10 (12% [41] of all patients), and high positive predictive value (>90% certainty of presence of F2, F3, F4) for scores ranging from 0.60 to 1.00 (34% [115] of all patients). On the FibroTest.com web site Poynard says "for scores ranging from 0 to 0.10 the probability of significant fibrosis is below 10% and treatment is usually not recommended in the absence of symptoms or risk of dissemination". In the Lancet article he also says his study results need to be repeated by another centre, but he thinks that the number of biopsies in the management of HCV could be reduced by up to 46%. My take is that this approach needs considerable research to confirm these findings. Additionally, strong confirmation of the cut-offs and margins of error are needed. Still, biopsy remains, in my opinion, the only sure way to evaluate the liver.