Abstract
OBJECTIVES:Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C.METHODS:We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed.RESULTS:A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively.CONCLUSION:Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.
Highlights
There are approximately 130 to 150 million carriers of the hepatitis C virus (HCV) worldwide
55-85% of patients with HCV develop the chronic form of the disease, and approximately 15-30% of these patients are at risk of developing cirrhosis within 20 years of diagnosis
High body mass index (BMI) can cause underestimation of fibrosis, and a skin-liver distance 42.5 cm increases the discrepancy compared with liver biopsy [34,35]
Summary
There are approximately 130 to 150 million carriers of the hepatitis C virus (HCV) worldwide. 55-85% of patients with HCV develop the chronic form of the disease, and approximately 15-30% of these patients are at risk of developing cirrhosis within 20 years of diagnosis. 300,000-500,000 people die each year as a result of CLINICS 2017;72(9):516525 complications arising from HCV [1]. In Brazil, hepatocellular carcinoma (HCC) is one of the most frequent complications of cirrhosis caused by HCV [2,3]. Liver biopsy is an invasive procedure that carries risks, sometimes causing pain, hemorrhage, and even death, among other complications [5]. Issues regarding the quality of the liver samples and interpretation of the results can occur. The quality of a liver biopsy is generally related to the length and number of portal spaces evaluated [6,7]. The results of the pathological anatomy can vary according to the subjective interpretation of the individual pathologist [8]
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