The safe (sequential algorithm for fibrosis evaluation) biopsy: A new approach to stage fibrosis in chronic hepatitis C

Background and aim. Several non-invasive markers for liver fibrosis have been described. Their use in combination algorithms has been proposed for clinical application. The SAFE biopsy combines sequentially AST-to-platelets ratio index (APRI) and fibrotest (FT) and requires liver biopsy only in cases in which these invasive markers are not of adequate accuracy. The SAFE biopsy uses two distinct algorithms to detect significant fibrosis (≥F2 by METAVIR) or cirrhosis (F4). Aim of this study was to validate the use of SAFE biopsy in hepatitis C in a large cohort of unselected patients with chronic HCV infection and to define variables that can affect its diagnostic performance.