title: Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study.
abstract: OBJECTIVE
  Blood tests and transient elastography (Fibroscan™) have been developed as alternatives to liver biopsy. This ANRS HCEP-23 study compared the diagnostic accuracy of nine blood tests and transient elastography (Fibroscan™) to assess liver fibrosis, vs. liver biopsy, in untreated patients with chronic hepatitis C (CHC).
  
  
  METHODS
  This was a multicentre prospective independent study in 19 French University hospitals of consecutive adult patients having simultaneous liver biopsy, biochemical blood tests (performed in a centralized laboratory) and Fibroscan™. Two experienced pathologists independently reviewed the liver biopsies (mean length=25±8.4 mm). Performance was assessed using ROC curves corrected by Obuchowski's method.
  
  
  RESULTS
  Fibroscan™ was not interpretable in 113 (22%) patients. In the 382 patients having both blood tests and interpretable Fibroscan™, Fibroscan™ performed similarly to the best blood tests for the diagnosis of significant fibrosis and cirrhosis. Obuchowski's measure showed Fibrometer® (0.86), Fibrotest® (0.84), Hepascore® (0.84), and interpretable Fibroscan™ (0.84) to be the most accurate tests. The combination of Fibrotest®, Fibrometer®, or Hepascore® with Fibroscan™ or Apri increases the percentage of well classified patients from 70-73% to 80-83% for significant fibrosis, but for cirrhosis a combination offers no improvement. For the 436 patients having all the blood tests, AUROC's ranged from 0.82 (Fibrometer®) to 0.75 (Hyaluronate) for significant fibrosis, and from 0.89 (Fibrometer® and Hepascore®) to 0.83 (FIB-4) for cirrhosis.
  
  
  CONCLUSIONS
  Contrarily to blood tests, performance of Fibroscan™ was reduced due to uninterpretable results. Fibrotest®, interpretable Fibroscan™, Fibrometer®, and Hepascore® perform best and similarly for diagnosis of significant fibrosis and cirrhosis.
authors.affiliation: Clinique Universitaire d'Hépato-Gastroentérologie-Pôle DIGIDUNE-CHU de Grenoble, France. JPZarski@chu-grenoble.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sturm
authors.forename: Jérôme
authors.initials: J
authors.lastname: Guechot
authors.forename: Adeline
authors.initials: A
authors.lastname: Paris
authors.forename: Elie-Serge
authors.initials: ES
authors.lastname: Zafrani
authors.forename: Tarik
authors.initials: T
authors.lastname: Asselah
authors.forename: Renée-Claude
authors.initials: RC
authors.lastname: Boisson
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Dominique
authors.initials: D
authors.lastname: Guyader
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Renversez
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bronowicki
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Gelineau
authors.forename: Albert
authors.initials: A
authors.lastname: Tran
authors.forename: Candice
authors.initials: C
authors.lastname: Trocme
authors.forename: Victor
authors.initials: V
authors.lastname: De Ledinghen
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lasnier
authors.forename: Armelle
authors.initials: A
authors.lastname: Poujol-Robert
authors.forename: Frédéric
authors.initials: F
authors.lastname: Ziegler
authors.forename: Marc
authors.initials: M
authors.lastname: Bourliere
authors.forename: Hélène
authors.initials: H
authors.lastname: Voitot
authors.forename: Dominique
authors.initials: D
authors.lastname: Larrey
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Rosenthal-Allieri
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard Hubert
authors.forename: François
authors.initials: F
authors.lastname: Bailly
authors.forename: Michel
authors.initials: M
authors.lastname: Vaubourdolle
mesh_terms: D000328:Adult; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D006403:Hematologic Tests; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies