Abstract
BackgroundFew studies have investigated predictors of discordance between liver biopsy (LB) and liver stiffness measurement (LSM) using FibroScan®. We assessed predictors of discordance between LB and LSM in chronic hepatitis B (CHB) and investigated the effects of necroinflammatory activity.MethodsIn total, 150 patients (107 men, 43 women) were prospectively enrolled. Only LSM with ≥10 valid measurements was considered reliable. Liver fibrosis was evaluated using the Laennec system. LB specimens <15 mm in length were considered ineligible. Reference cutoff LSM values to determine discordance were calculated from our cohort (6.0 kPa for ≥F2, 7.5 kPa for ≥F3, and 9.4 kPa for F4).ResultsA discordance, defined as a discordance of at least two stages between LB and LSM, was identified in 21 (14.0%) patients. In multivariate analyses, fibrosis stages F3–4 and F4 showed independent negative associations with discordance (P = 0.002; hazard ratio [HR], 0.073; 95% confidence interval [CI], 0.014–0.390 for F3–4 and P = 0.014; HR, 0.067; 95% CI, 0.008–0.574 for F4). LSM values were not significantly different between maximal activity grades 1–2 and 3–4 in F1 and F2 fibrosis stages, whereas LSM values were significantly higher in maximal activity grade 3–4 than 1–2 in F3 and F4 fibrosis stage (median 8.6 vs. 11.3 kPa in F3, P = 0.049; median 11.9 vs. 19.2 kPa in F4, P = 0.009).ConclusionAdvanced fibrosis stage (F3–4) or cirrhosis (F4) showed a negative correlation with discordance between LB and LSM in patients with CHB, and maximal activity grade 3–4 significantly influenced LSM values in F3 and F4.
Highlights
Because the prognosis of and management strategies for patients with chronic liver diseases depend strongly on the severity of liver fibrosis, early detection of significant fibrosis is key [1]
Liver stiffness measurement (LSM) using FibroScanH was introduced as a noninvasive device to accurately assess liver fibrosis [5]
In addition to these extrinsic factors, liver stiffness measurement (LSM) should satisfy the intrinsic prerequisites for preserving the validity of LSM: $10 valid measurements, a success rate $60%, and an interquartile range (IQR)/median LSM value among valid measurements (IQR/M),0.3
Summary
Because the prognosis of and management strategies for patients with chronic liver diseases depend strongly on the severity of liver fibrosis, early detection of significant fibrosis is key [1]. Despite the clinical usefulness of LSM, several confounding factors that can diminish the accuracy of LSM have been identified, such as necroinflammatory activity, reflected by a high alanine aminotransferase (ALT) level, cholestasis, or heart failure [6,7,8,9,10,11,12] In addition to these extrinsic factors, LSM should satisfy the intrinsic prerequisites for preserving the validity of LSM: $10 valid measurements, a success rate $60%, and an interquartile range (IQR)/median LSM value among valid measurements (IQR/M) ,0.3. Because these criteria are not based on scientific evidence, several studies have tried to demonstrate the clinical relevance of these criteria by identifying factors that predict discordant results between LB and LSM in estimating liver fibrosis. We assessed predictors of discordance between LB and LSM in chronic hepatitis B (CHB) and investigated the effects of necroinflammatory activity
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