title: Larger biopsies evaluation of transient elastography for detecting advanced fibrosis in patients with compensated chronic hepatitis B.
abstract: OBJECTIVE
  Although larger biopsies sample had been recommended for the study of non-invasive liver fibrosis assessment, few studies with larger biopsies for transient elastography (TE) detecting liver fibrosis had been reported. The present study tries to re-evaluate the performance of TE for detecting advanced fibrosis (≥F3) with larger biopsies in patients with compensated chronic hepatitis B.
  
  
  METHODS
  A total of 375 compensated patients were analyzed, who had undergone liver biopsy, reliable TE and routine blood tests.
  
  
  RESULTS
  The area under the receiver operating characteristic curve (AUC) was influenced by liver biopsy sample: 0.873 (95% confidence interval 0.838-0.909) in total patients, 0.880 (0.844-0.917) in length ≥ 15 mm, 0.897 (0.863-0.932) in length ≥ 20 mm and 0.911 (0.874-0.949) in length ≥ 25 mm. In patients with sample length ≥ 20 mm, the cutoffs to exclude and confirm advanced fibrosis were 7.1 kPa and 12.7 kPa, respectively. Stratified by alanine aminotransferase of two times the upper limit of normal (ALT 2 × ULN), transient elastography detecting advanced fibrosis with the most efficiency by 72.5% of patients obviated from liver biopsy. In patients with normal bilirubin and ALT < 2 × ULN, the area was 0.921 (0.860-0.982), and cutoffs for excluding and confirming diagnosis were 7.4 kPa and 10.6 kPa, respectively; 80% of patients could be classified with or without advanced fibrosis (AF). In patients with normal bilirubin and ALT ≥ 2 × ULN, the corresponding numbers were 0.885 (0.824-0.947), 7.5 kPa, 12.7 kPa and 79.2%, respectively.
  
  
  CONCLUSIONS
  Inadequate sample study would underestimate the efficiency of TE on detecting advanced fibrosis. With ALT 2 × ULN stratified cutoffs, TE determined nearly 80% of patients with normal bilirubin as AF or non-AF and obviated them from liver biopsies.
authors.affiliation: Department of Infectious Disease, Nanfang Hospital, Guangzhou, China.
authors.forename: Yong Peng
authors.initials: YP
authors.lastname: Chen
authors.forename: Xie Er
authors.initials: XE
authors.lastname: Liang
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Peng
authors.forename: You Fu
authors.initials: YF
authors.lastname: Zhu
authors.forename: Wei Qun
authors.initials: WQ
authors.lastname: Wen
authors.forename: Jin Lin
authors.initials: JL
authors.lastname: Hou
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004812:Epidemiologic Methods; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000821:virology
chemical_list: D015415:Biomarkers; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase; D001663:Bilirubin