title: Liver stiffness measurement in the risk assessment of hepatocellular carcinoma for patients with chronic hepatitis.
abstract: OBJECTIVE
  [corrected] The risk of hepatocellular carcinoma (HCC) increased with progression of hepatic fibrosis as assessed by liver stiffness measurement (LSM). This study used LSM to assess the risk of HCC presence in patients with chronic hepatitis.
  
  
  METHODS
  The patients with liver tumor or chronic hepatitis indicated for biopsy were prospectively enrolled. LSM was performed on the same day as biopsy. The diagnostic performances of clinical parameters and LSM in predicting HCC presence were compared with the areas under receiver operating characteristics curves (AUROC). The risk of HCC presence was assessed with stratum-specific likelihood ratios (SSLR). The cut-off values and its diagnostic validity were calculated for LSM.
  
  
  RESULTS
  A total of 435 patients, including 106 HCC and 329 chronic hepatitis, were enrolled. The AUROC in predicting HCC presence was 0.736, 0.733, 0.594, 0.579 and 0.532 for LSM, alpha-fetoprotein, platelet count, total bilirubin, and aspartate aminotransferase-platelet ratio index, respectively. Multivariate analysis showed liver stiffness was an independent factor for HCC presence (odds ratio 1.07, 95% confidence interval (CI) 1.05-1.09). SSLR for HCC presence by liver stiffness was 0.43 (95% CI 0.32-0.57) in <12 kPa, 1.28 (0.89-1.84) in 12-24 kPa, and 5.94 (3.77-9.35) in >24 kPa. With 12 and 24 kPa as the cut-offs in predicting HCC presence, the sensitivity was 69.8 and 41.5%, respectively. The specificity was 69.6 and 92.7%, respectively.
  
  
  CONCLUSIONS
  LSM identified the risk group for HCC presence in chronic hepatitis patients and had high specificity in the prediction of HCC with the cut-off of 24 kPa.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung, Kaohsiung, 833 Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Kuo
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Kwong-Ming
authors.initials: KM
authors.lastname: Kee
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang