title: A brief review on molecular, genetic and imaging techniques for HCV fibrosis evaluation.
abstract: BACKGROUND
  Chronic HCV is one of the major causes of morbidity and mortality in the present day world. The assessment of disease progression not only provides useful information for diagnosis and therapeutic supervision judgment but also for monitoring disease. Different invasive and non invasive methods are applied to diagnose the disease from initial to end stage (mild fibrosis to cirrhosis). Although, liver biopsy is still considered as gold standard to identify liver histological stages, an assessment of the disease development based on non-invasive clinical findings is also emerging and this may replace the need of biopsy in near future. This review gives brief insight on non-invasive methods currently available for predicting liver fibrosis in HCV with their current pros and cons to make easier for a clinician to choose better marker to assess liver fibrosis in HCV infected patients.
  
  
  METHODS
  More than 200 studies regarding invasive and noninvasive markers available for HCV liver disease diagnosis were thoroughly reviewed. We examined year wise results of these markers based on their sensitivity, specificity, PPV, NPV and AUROCs.
  
  
  RESULTS
  We found that in all non-invasive serum markers for HCV, FibroTest, Forn's Index, Fibrometer and HepaScore have high five-year predictive value but with low AUROCs (0.60~0.85) and are not comparable to liver biopsy (AUROC = 0.97). Even though from its beginning, Fibroscan is proved to be best with high AUROCs (> 0.90) in all studies, no single noninvasive marker is able to differentiate all fibrosis stages from end stage cirrhosis. Meanwhile, specific genetic markers may not only discriminate fibrotic and cirrhotic liver but also differentiate individual fibrosis stages.
  
  
  CONCLUSIONS
  There is a need of marker which accurately determines the stage based on simplest routine laboratory test. Genetic marker in combination of imaging technique may be the better non invasive diagnostic method in future.
authors.affiliation: Applied and Functional Genomics Laboratory, Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan.
authors.forename: Waqar
authors.initials: W
authors.lastname: Ahmad
authors.forename: Bushra
authors.initials: B
authors.lastname: Ijaz
authors.forename: Sana
authors.initials: S
authors.lastname: Gull
authors.forename: Sultan
authors.initials: S
authors.lastname: Asad
authors.forename: Saba
authors.initials: S
authors.lastname: Khaliq
authors.forename: Shah
authors.initials: S
authors.lastname: Jahan
authors.forename: Muhammad T
authors.initials: MT
authors.lastname: Sarwar
authors.forename: Humera
authors.initials: H
authors.lastname: Kausar
authors.forename: Aleena
authors.initials: A
authors.lastname: Sumrin
authors.forename: Imran
authors.initials: I
authors.lastname: Shahid
authors.forename: Sajida
authors.initials: S
authors.lastname: Hassan
mesh_terms: D000818:Animals; D003952:Diagnostic Imaging / Q000379:methods*; D005819:Genetic Markers; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology
chemical_list: D005819:Genetic Markers