title: Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C.
abstract: Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment by liver biopsy (LB) can help determine therapy. However, biopsy is an invasive procedure with several limitations. A new, noninvasive medical device based on transient elastography has been designed to measure liver stiffness. The aim of this study was to investigate the use of liver stiffness measurement (LSM) in the evaluation of liver fibrosis in patients with chronic hepatitis C. We prospectively enrolled 327 patients with chronic hepatitis C in a multicenter study. Patients underwent LB and LSM. METAVIR liver fibrosis stages were assessed on biopsy specimens by 2 pathologists. LSM was performed by transient elastography. Efficiency of LSM and optimal cutoff values for fibrosis stage assessment were determined by a receiver-operating characteristics (ROC) curve analysis and cross-validated by the jack-knife method. LSM was well correlated with fibrosis stage (Kendall correlation coefficient: 0.55; P < .0001). The areas under ROC curves were 0.79 (95% CI, 0.73-0.84) for F > or =2, 0.91 (0.87-0.96) for F > or =3, and 0.97 (0.93-1) for F=4; for larger biopsies, these values were, respectively, 0.81, 0.95, and 0.99. Optimal stiffness cutoff values of 8.7 and 14.5 kPa showed F > or =2 and F=4, respectively. In conclusion, noninvasive assessment of liver stiffness with transient elastography appears as a reliable tool to detect significant fibrosis or cirrhosis in patients with chronic hepatitis C.
authors.affiliation: UPRES EA 3406, University of Paris 13, Bobigny, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Ziol
authors.forename: Adriana
authors.initials: A
authors.lastname: Handra-Luca
authors.forename: Adrien
authors.initials: A
authors.lastname: Kettaneh
authors.forename: Christos
authors.initials: C
authors.lastname: Christidis
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mal
authors.forename: Farhad
authors.initials: F
authors.lastname: Kazemi
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Daniel
authors.initials: D
authors.lastname: Dhumeaux
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D000328:Adult; D001706:Biopsy; D004548:Elasticity; D005260:Female; D005762:Gastroenterology / Q000295:instrumentation / Q000379:methods; D019698:Hepatitis C, Chronic / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve