Two years ago, in response to the demand of some patients, I wrote “How to detect early cirrhosis in time”, which was quite popular; however, in the past two years, the unexpected development of the disease in some patients made me worry about the value of “detecting early cirrhosis in time”. Among the patients I am still following up regularly, three of them unexpectedly developed “liver cancer” even though their disease was well controlled and their quality of life and quality of work were no different from normal people, one of them was not informed of the ultrasound examination in time due to his own negligence, and his disease developed rapidly and he passed away in just 9 months. Fortunately, the other two patients underwent surgery in time. These things touched me a lot: for the prevention of liver cancer, early detection of cirrhosis is not enough, because cirrhosis is a high risk factor for liver cancer, with cirrhosis, liver cancer is possible. Studies have found that among Asians, the chance of chronic hepatitis B without cirrhosis developing into liver cancer is only 0.6%, while the incidence of liver cancer among hepatitis B patients with cirrhosis is as high as 3.7%; such facts tell us that in order to prevent liver cancer from occurring, we must detect the trend of cirrhosis in time and block cirrhosis from the door; preventing cirrhosis from occurring is the root of preventing liver cancer. There are also some cirrhotic patients who are still suffering from the main complication of cirrhosis, esophageal and fundic variceal bleeding, even though their liver function has returned to normal after treatment and their ability to live and work is not restricted! All the above encounters have made me feel deeply that early detection of cirrhosis and timely treatment are far from enough. In order to prevent liver cancer and the major complications of cirrhosis, it is essential to provide antiviral intervention before the onset of cirrhosis. For hepatitis B, hepatitis B virus replication (i.e., HBV DNA above 10,000 copies/mL) is the culprit, and only by controlling hepatitis B virus replication can we fundamentally control the development of liver fibrosis; however, clinical experience tells us that the treatment of hepatitis B, whether it is interferon, or oral drugs such as Boludin and Sulbivir, is not 100% effective. However, clinical experience tells us that the treatment of hepatitis B with interferon, oral medications such as Boludin and Sulbivir is not 100% effective, and the duration of oral medications is not certain. In fact, there is only the shortest course of oral medication, not the longest, which means that when the efficacy of oral medication is not optimal, the course of treatment is unpredictable, so we must have a good understanding of this when we choose oral medication, especially for young women with fertility requirements. In fact, not all hepatitis B virus infections require treatment, and as long as the disease does not progress to cirrhosis, our livers should actually still be vibrant and vigorous! Studies have found that the annual incidence of cirrhosis in inactive HBsAg carriers is less than 0.1%; in East Asia, the annual incidence of cirrhosis in HBeAg-positive (i.e., “major triple-positive”) adult hepatitis B patients is 1.6%, while the 5-year cumulative incidence is 8%; while HBeAg-negative (i.e. “minor triple-positive”) the corresponding figures are 2.8% and 13%, respectively. This shows that not all hepatitis B patients need antiviral therapy. The ensuing question is, which patients are the ones who need timely treatment? This is the purpose of this article! In the diagnosis of liver fibrosis, it is medically divided into 4 stages, which are called S1, S2, S3 and S4 in our country: S1 is just fibrosis in the confluent area of the liver, just like street garbage in the city, which is not a big problem if not treated immediately; S2 is a small amount of fibrosis that has been connected to each other and formed intervals, just like a small amount of illegal buildings in the city, but it just affects the cityscape, which is the basis for the formation of cirrhosis and needs to be alert; and S3 is a prelude to cirrhosis, similar to a city’s illegal building, which affects the city planning and needs to be cleaned up in time; S4 indicates the formation of cirrhosis, and timely cleaning may restore the vitality of the liver, but some deep-rooted “illegal buildings” are already There is nothing that can be done, leading to complications such as liver cancer and esophageal varices inevitably. I believe we have come to understand that timely detection of liver fibrosis S3 and effective intervention is the ideal measure in terms of cost effectiveness (cost-effectiveness) of drug therapy. Among the available medical treatments, liver aspiration biopsy is the “gold standard”; however, if the specimen obtained by liver aspiration is insufficient (less than 2 cm in length), liver aspiration may underestimate the degree of liver fibrosis (i.e., it is actually liver fibrosis S3, but liver aspiration diagnoses S2 or less), which is very damaging! Thus, it is requested to obtain enough specimens by increasing the number of liver punctures, but as we all know, liver puncture is an invasive operation, and 1 puncture is already a bit worrisome, and I believe most patients are not too willing if they have to have 2 or more punctures! However, if liver puncture is not possible, the currently widely available laboratory tests and ultrasound examinations cannot detect liver fibrosis S3. It seems that the only way to detect fibrosis is by liver aspiration! Happily, in recent years, the transient elastography (also known as FibroScan, liver fibrosis scan, liver stiffness test, etc.), which started in Europe, can solve this problem for most patients! Currently, this screening tool is available in China, but for some reasons, this technique has not been widely used in the country. In our nearly 4 years of clinical experience, this instrument allows more than 70% of patients to determine the presence or absence of liver fibrosis S3 and the need for immediate antiviral therapy to control the progression of cirrhosis as early as possible, although nearly 30% of patients still need liver biopsy to understand the extent of liver fibrosis. In our experience, patients with liver elasticity values below 7.5 kPa can basically exclude the possibility of liver fibrosis S3, while for patients with ALT below 80 U/L, liver elasticity values above 11.8 kPa indicate the presence of liver fibrosis S3 and require immediate treatment, and in the case of ALT above 80 U/L, this figure needs to be increased to 12.7 kPa; in addition, for patients with liver elasticity values of 9.8-11.8kPa, although it is not clear whether there is a tendency of cirrhosis (S3), the presence of interval liver fibrosis (S2) can be determined, and they belong to the group of people who can be considered for antiviral treatment, and liver biopsy can be disregarded if antiviral treatment is started. The occurrence of cirrhosis and hepatocellular carcinoma is multifaceted, among which family and alcohol abuse are also important factors. If there are patients with cirrhosis and hepatocellular carcinoma in the family, monitoring of liver fibrosis should be given high priority; of course, the prohibition of alcohol consumption is a clear requirement for every hepatitis B patient, which is not negotiable.