title: Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B.
abstract: BACKGROUND
  The need for new non-invasive tools to assess liver fibrosis in chronic liver diseases has been largely advocated. Liver stiffness measurement (LSM) using transient elastography (FibroScan), Echosens) has been shown to be correlated to liver fibrosis in various chronic liver diseases. This study aims to assess its diagnosis accuracy in patients with chronic hepatitis B.
  
  
  METHODS
  We prospectively enrolled 202 patients with chronic hepatitis B in a multicentre study. Patients underwent liver biopsy (LB) and LSM. METAVIR and Ishak liver fibrosis stages were assessed by two pathologists.
  
  
  RESULTS
  LSM or LB was considered unreliable in 29 patients. Statistical analysis was conducted in 173 patients. LSM was significantly (P<0.001) correlated with METAVIR (r=0.65) and Ishak fibrosis stage (0.65). The area under receiver-operating characteristic curves were 0.81 (95% confidence intervals, 0.73-0.86) for F>/=2, 0.93 (0.88-0.96) for F>/=3 and 0.93 (0.82-0.98) for F=4. Optimal LSM cut-off values were 7.2 and 11.0 kPa for F>/=2 and F=4, respectively, by maximizing the sum D of sensitivity and specificity, and 7.2 and 18.2 kPa by maximizing the diagnosis accuracy.
  
  
  CONCLUSIONS
  In conclusion, LSM appears to be reliable for detection of significant fibrosis or cirrhosis in HBV patients and cut-off values are only slightly different from those observed in HCV patients.
authors.affiliation: Service d'Hépatologie and INSERM U 773, Hôpital Beaujon, AP-HP, University of Paris, Clichy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Marianne
authors.initials: M
authors.lastname: Ziol
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.forename: Catherine
authors.initials: C
authors.lastname: Douvin
authors.forename: Raoul
authors.initials: R
authors.lastname: Poupon
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies