Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.
OBJECTIVE
Transient elastography (FibroScan; Echosens, Paris, France) is a novel, noninvasive, and rapid bedside method to assess liver fibrosis by measuring liver stiffness. We prospectively assessed the performance of FibroScan in patients with chronic hepatitis C, in comparison with and combined with currently available biochemical markers (Fibrotest; Biopredictive; and the aspartate transaminase to platelets ratio index [APRI]); a liver biopsy examination performed the same day served as the reference.


METHODS
We studied 183 consecutive patients with chronic hepatitis C (METAVIR fibrosis stage F1, n = 47; F2, n = 53; F3, n = 37; F4, n = 46).


RESULTS
FibroScan values ranged from 2.4 to 75.4 kilopascals (median, 7.4 kilopascals). Cut-off values were 7.1 kPa for F > or = 2, 9.5 kPa for F > or = 3, and 12.5 kPa for F = 4. The areas under the receiver operating characteristic (ROC) curve of FibroScan, FibroTest, and APRI values were of the same order (.83, .85, and .78, respectively, for F > or = 2; .90, .90, and .84, respectively, for F > or = 3; and .95, .87, and .83, respectively, for F = 4). The best performance was obtained by combining the FibroScan and FibroTest, with areas under the ROC curve of .88 for F > or = 2, .95 for F > or = 3, and .95 for F = 4. When the FibroScan and FibroTest results agreed, liver biopsy examination confirmed them in 84% of cases for F > or = 2, in 95% for F > or = 3, and in 94% for F = 4.


CONCLUSIONS
FibroScan is a simple and effective method for assessing liver fibrosis, with similar performance to FibroTest and APRI. The combined use of FibroScan and FibroTest to evaluate liver fibrosis could avoid a biopsy procedure in most patients with chronic hepatitis C.
Castéra
Laurent
L
Service d'Hépato-gastroentérologie, Hôpital Haut Lévêque, C. H. U. Bordeaux, Pessac, France. laurent.catera@chu-bordeaux.fr
Vergniol
Julien
J
Foucher
Juliette
J
Le Bail
Brigitte
B
Chanteloup
Elise
E
Haaser
Maud
M
Darriet
Monique
M
Couzigou
Patrice
P
De Lédinghen
Victor
V
D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004548:Elasticity; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D015415:Biomarkers; D001219:Aspartate Aminotransferases