Comparison of the liver stiffness measurement by transient elastography with the liver biopsy.
OBJECTIVE
To compare the liver stiffness (LS) measurement by transient elastography (TE) to the liver biopsy (LB)-considered the "gold standard" in the evaluation of patients with chronic hepatitis C.


METHODS
During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus (HCV), in which LB and LS assessments (by means of TE) were performed during the same session.


RESULTS
Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 +/- 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with significant fibrosis at biopsy (161 patients with F >= 2 according to Metavir) was 9.02 +/- 5.15 kPa, significantly higher than in patients with no or mild fibrosis (30 patients with F < 2 Metavir): 5.39 +/- 1.81 kPa (P < 0.0001). For a cut-off value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis (at least F2 Metavir), with a diagnostic performance of 77.3% (AUROC 0.773). Using this cut-off value, we reached the best discrimination between absence of fibrosis/mild fibrosis (F < 2 Metavir) and the presence of moderate to severe fibrosis (F >= 2 Metavir).


CONCLUSIONS
In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.
Sporea
Ioan
I
Department of Gastroenterology, University of Medicine and Pharmacy, 13, Snagov str., Timisoara 300472, Romania. isporea@umft.ro
Sirli
Roxana
R
Deleanu
Alexandra
A
Tudora
Adriana
A
Curescu
Manuela
M
Cornianu
Marioara
M
Lazar
Daniela
D
D000328:Adult; D001707:Biopsy, Needle; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index