title: Assessment of biliary fibrosis by transient elastography in patients with PBC and PSC.
abstract: Noninvasive measurement of liver stiffness with transient elastography has been recently validated for the evaluation of hepatic fibrosis in chronic hepatitis C. The current study assessed the diagnostic performance of liver stiffness measurement (LSM) for the determination of fibrosis stage in chronic cholestatic diseases. One hundred one patients with primary biliary cirrhosis (PBC, n=73) or primary sclerosing cholangitis (PSC, n=28) were prospectively enrolled in a multicenter study. All patients underwent liver biopsy (LB) and LSM. Histological and fibrosis stages were assessed on LB by two pathologists. LSM was performed by transient elastography. Efficiency of LSM for the determination of histological and fibrosis stages were determined by a receiver operating characteristics (ROC) curve analysis. Analysis failed in six patients (5.9%) because of unsuitable LB (n=4) or LSM (n=2). Stiffness values ranged from 2.8 to 69.1 kPa (median, 7.8 kPa). LSM was correlated to both fibrosis (Spearman's rho= 0.84, P < .0001) and histological (0.79, P < .0001) stages. These correlations were still found when PBC and PSC patients were analyzed separately. Areas under ROC curves were 0.92 for fibrosis stage (F) > or =2, 0.95 for F > or =3 and 0.96 for F=4. Optimal stiffness cutoff values of 7.3, 9.8, and 17.3 kPa showed F > or =2, F > or =3 and F=4, respectively. LSM and serum hyaluronic acid level were independent parameters associated with extensive fibrosis on LB. In conclusion, transient elastography is a simple and reliable noninvasive means for assessing biliary fibrosis. It should be a promising tool to assess antifibrotic therapies in PBC or PSC.
authors.affiliation: Service d'Hépatologie, Centre national de référence des maladies inflammatoires du foie et des voies biliaires, Hôpital Saint-Antoine, Paris, France. cristophe.corpechot@sat.aphp.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Corpechot
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Naggar
authors.forename: Armelle
authors.initials: A
authors.lastname: Poujol-Robert
authors.forename: Marianne
authors.initials: M
authors.lastname: Ziol
authors.forename: Dominique
authors.initials: D
authors.lastname: Wendum
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouillères
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Daniel
authors.initials: D
authors.lastname: Dhumeaux
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
authors.forename: Raoul
authors.initials: R
authors.lastname: Poupon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D004548:Elasticity; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies