title: Liver stiffness measurement versus clinicians' prediction or both for the assessment of liver fibrosis in patients with chronic hepatitis C.
abstract: OBJECTIVE
  The goal of this study was to estimate the additional value of liver stiffness measurement (LSM) with physicians' assessment of fibrosis based on epidemiological, clinical, and biological parameters.
  
  
  METHODS
  One hundred forty-two unselected patients with chronic hepatitis C were included. Liver biopsy and LSM were performed simultaneously. First, four physicians (two junior residents with limited experience in hepatology and two senior hepatologists) independently predicted the stage of fibrosis according to the METAVIR classification, using clinical, epidemiological, and biological data. For the second step, they were informed of LSM values and could modify their first evaluation if necessary. Finally, the two successive evaluations were compared with the histological fibrosis score.
  
  
  RESULTS
  Providing LSM values improved agreement between physicians and resulted in a better correlation between clinical impression and histological liver fibrosis. The diagnostic performances were only significantly improved with transient elastography for the diagnosis of cirrhosis where assessment improved in three of the four physicians (AUROC [area under receiver operating characteristic curve]: 0.76 vs 0.87, 0.80 vs 0.87, and 0.83 vs 0.89, all p < 0.05). Moreover, these performances were nearly similar for junior and senior physicians when LSM was provided with the AUROC ranging from 0.69 to 0.72 for significant fibrosis and 0.87 to 0.90 for cirrhosis.
  
  
  CONCLUSIONS
  Providing LSM values to physicians results in a better estimation of liver fibrosis and a more accurate diagnosis of cirrhosis. Moreover, it allows physicians with limited experience to predict liver fibrosis as well as experienced hepatologists.
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, AP-HP, Bondy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Marianne
authors.initials: M
authors.lastname: Ziol
authors.forename: Myint Tin-Tin
authors.initials: MT
authors.lastname: Htar
authors.forename: Fabien
authors.initials: F
authors.lastname: Cesaro
authors.forename: Nathalie
authors.initials: N
authors.lastname: Barget
authors.forename: Véronique
authors.initials: V
authors.lastname: Grando-Lemaire
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrie
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004548:Elasticity; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results