title: Evaluation of transient elastography for fibrosis assessment compared with large biopsies in chronic hepatitis B and C.
abstract: BACKGROUND
  Fibrosis determines prognosis and management in patients with chronic hepatitis B and C (CHB and CHC). Transient elastography (TE) is a promising non-invasive method to assess fibrosis. We prospectively studied the performance of TE compared to histology and also whether there are differences between CHB and CHC. Only large biopsies (≥ 25 mm) were used.
  
  
  METHODS
  We included 241 patients with CHB (n = 125) and CHC (n = 116), of whom we acquired 257 liver biopsies, all preceded by elastography. We correlated liver stiffness with fibrosis stage according to the METAVIR system, inflammation (Histology Activity Index), steatosis and iron. The impact of gender, age, body mass index, alcohol, alanine aminotransferase levels, platelet count, viral load and genotype on liver stiffness was evaluated.
  
  
  RESULTS
  The AUROC's for F ≥ 2 were 0.85 for CHB and 0.76 for CHC. AUROC's for F ≥ 3 were 0.91 for CHB and 0.87 for CHC and 0.90 and 0.91 for F4 for CHB and CHC respectively. For F ≥ 2 the cut-off value was 6.0 kPa for CHB and 5.0 kPa for CHC. The cut-off values for ≥ F3 were 9.0 and 8.0 kPa for CHB and CHC, respectively, and 13.0 kPa for F4 in both CHB and CHC patients. Besides inflammation, all other remaining factors do not influence liver stiffness.
  
  
  CONCLUSIONS
  For the diagnosis of fibrosis stages F ≤ 2 TE is suboptimal, and inflammation may induce higher values. For stages F ≥ 3 TE performance is good and equal in both CHB and CHC patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Verveer
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Zondervan
authors.forename: Fibo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
mesh_terms: D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000428:Alcohol Drinking; D001706:Biopsy; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005602:France; D005838:Genotype; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006652:Histological Techniques; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D012372:ROC Curve; D012737:Sex Factors; D014766:Viremia
chemical_list: D000410:Alanine Transaminase