Liver stiffness measurement versus clinicians' prediction or both for the assessment of liver fibrosis in patients with chronic hepatitis C.
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.
Nahon
Pierre
P
Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, AP-HP, Bondy, France.
Thabut
Gabriel
G
Ziol
Marianne
M
Htar
Myint Tin-Tin
MT
Cesaro
Fabien
F
Barget
Nathalie
N
Grando-Lemaire
Véronique
V
Ganne-Carrie
Nathalie
N
Trinchet
Jean-Claude
JC
Beaugrand
Michel
M
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