Can non-invasive assessment of liver fibrosis replace liver biopsy?

Transient elastgraphy, acoustic radiation force impulse and real‐time elastography are the methods with very good or excellent diagnostic accuracy for the assessment of liver fibrosis stage. They do not provide the information on inflammatory activity, steatosis, iron deposition or other findings derived from liver biopsy. Even on account of fibrosis stage, these non‐invasive methods do not give us the estimation completely corresponding to that of liver biopsy. However they provide us useful clinical information that liver biopsy has been providing us, such as appropriate time to start antiviral therapy, prediction of response to antiviral therapy, evaluation of effects of antiviral therapy, assessment of natural course of hepatitis and estimation of prognosis of hepatitis. Recently non‐invasive methods for assessment of inflammatory activity, steatosis and iron deposition in the liver have been developed. Thus in the near future, non‐invasive methods will replace liver biopsy.