Liver biopsy is the gold standard for the most accurate diagnosis of MTX-induced hepatic fibrosis and cirrhosis, but routine liver biopsies in monitoring patients receiving long-term MTX is controversial. What may the alternate reliable laboratory test/tests to monitor hepatic fibrosis who is on long term MTX therapy?
In order to avoid liver biopsy, you could estimate liver fibrosis by using fibroscan (transient elastography) or even though not the gold standard, MRI or U/S .
Undoubtedly, liver biopsy is the gold standard in monitoring fibrosis, but it's invasive.
Transient elastography (TE) could be a reliable approach to monitor the fibrosis. However, TE may not be available in all centers. Routine blood test monitoring liver enzymes, and positive tests will proceed ultrasound or liver biopsy would be an alternative.
The routinary use of fibroscan has a great aid to decretase the performance of Oliver biopsias at a mínimum degree
When evaluating laboratory tests included in the non-invasive fibrosis diagnosis kits, it must be remembered that they were validated to diagnose fibrosis in chronic viral or alcoholic hepatitis.
In addition, the potential effect of metortexate on laboratory tests must be considered in order to avoid false positive and false negative results.
A liver biopsy is of course the gold standard. But it is very curious from the execution technique.
Elastography , in my opinion, may well be an alternative.
Sincerely,
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