Why move away from liver biopsy?
Although it remains useful in complex situations, liver biopsy has several limitations²:
– Invasive, with a risk of complications (pain, bleeding).
– Limited sampling: a fragment representing 1/50,000 of the liver.
– Inter-observer variability in interpretation.
– High cost and complex logistics.
– Low patient acceptance, limiting longitudinal follow-up.
International recommendations (EASL, AASLD, AGA…)²⁻⁴ now converge:
Non-invasive tests should be used as a first-line approach to assess fibrosis in most chronic liver diseases. foie.
Non-invasive tests: to be used as first-line approach
Several technologies are available, but Vibration-Controlled Transient Elastography (VCTE®) is the most clinically validated, the most standardized, and also the most cited in the recommendations of scientific societies (EASL, AGA, AASLD, Baveno…).
LSM by VCTE®: the reference for non-invasive fibrosis assessment
The LSM by VCTE® (Liver Stiffness Measurement) marker from FibroScan® enables the measurement of liver stiffness, expressed in kilopascals (kPa). It is a quantitative, reproducible biomarker validated in most chronic liver diseases:
– Metabolic liver diseases (MASLD / MASH)
– Viral hepatitis (B, C, Delta)
– ALD / MetALD
– Autoimmune diseases
– Cirrhosis
LSM by VCTE® is also supported by international scientific validation, with more than 5,540 publications on the clinical value of liver stiffness measurement (LSM by VCTE®).
LSM by VCTE® in clinical practice: a decision-making tool
1. Identify patients at riske
In patients with metabolic risk factors (diabetes, obesity, metabolic syndrome), a high LSM by VCTE® value helps rapidly identify those requiring specialized care.
2. Reduce the need for liver biopsy
International recommendations¹ support the use of non-invasive tests to:
– Exclude the presence of advanced fibrosis (low LSM by VCTE® + low blood test result).
– Confirm the presence of advanced fibrosis (high LSM by VCTE® + high blood test result).
Liver biopsy is reserved only for discordant or complex cases.
3. Monitor disease progression
– The non-invasive nature of the examination with VCTE®.
– Assessment of therapeutic response⁵.
– Monitoring of patients with MASLD/MASH⁵.
– Detection of cirrhosis and assessment of spleen stiffness in a clinical setting⁶.
Liver fibrosis assessment no longer relies solely on liver biopsy. Non-invasive examinations, and particularly LSM by VCTE®, are now the preferred method for identifying, stratifying, and monitoring patients with chronic liver diseases.
1. European Association for the Study of the Liver (EASL) et al. “EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).” Journal of hepatology vol. 81,3 (2024): 492-542.
2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. Journal of Hepatology. 2021;75(3):659-689.
3. Rinella, Mary E et al. “AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease.” Hepatology (Baltimore, Md.) vol. 77,5 (2023): 1797-1835
4. Bril, Fernando. “Metabolic liver disease: A summary of major guidelines and identifying opportunities to improve future guidelines.” Diabetes, obesity & metabolism vol. 28 Suppl 2,Suppl 2 (2026): 63-80.
5. Bansal, Meena B et al. “Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD Practice Guidance.” Hepatology (Baltimore, Md.) vol. 83,5 (2026): 1326-1340.
6. de Franchis, Roberto et al. “Baveno VII – Renewing consensus in portal hypertension.” Journal of hepatology vol. 76,4 (2022): 959-974.
The FibroScan device (Models: 502 Touch, 530 Compact, 430 Mini+, 230, and 630) is intended to measure liver stiffness (E) using Vibration Controlled Transient Elastography (VCTE) at 50 Hz shear wave frequency and liver ultrasound attenuation coefficient (CAP)* at 3.5 MHz. FibroScan 630 Expert is also intended to measure spleen stiffness using VCTE at 100 Hz shear wave frequency. FibroScan liver stiffness measurements (LSM) by VCTE may aid the physician in determining the likelihood of cirrhosis and may be used, taken in context with other clinical and laboratory data, as an aid in the assessment of liver fibrosis. FibroScan CAP measurements may be used, taken in context with other clinical and laboratory data, as an aid in the assessment of hepatic steatosis. FibroScan is indicated as a non-invasive aid for the clinical management, diagnosis, and monitoring of adult and pediatric patients with confirmed or suspected liver disease, as part of an overall assessment of the liver. Results in the pediatric population should be interpreted while considering the clinical condition and the overall patient profile. The FibroScan device is intended for use by healthcare professionals in hospitals, clinics or any facility where healthcare is provided. *CAP refers to ultrasound attenuation coefficient (originally defined as Controlled Attenuation Parameter). CAP on S+ probe is only available with SmartExam capability.
