title: Precise evaluation of liver histology by computerized morphometry shows that steatosis influences liver stiffness measured by transient elastography in chronic hepatitis C.
abstract: BACKGROUND
  Liver stiffness evaluation (LSE) by Fibroscan is now widely used to assess liver fibrosis in chronic hepatitis C. Liver steatosis is a common lesion in chronic hepatitis C as in other chronic liver diseases, but its influence on LSE remains unclear. We aimed to precisely determine the influence of steatosis on LSE by using quantitative and precise morphometric measurements of liver histology.
  
  
  METHODS
  650 patients with chronic hepatitis C, liver biopsy, and LSE were included. Liver specimens were evaluated by optical analysis (Metavir F and A, steatosis grading) and by computerized morphometry to determine the area (%, reflecting quantity) and fractal dimension (FD, reflecting architecture) of liver fibrosis and steatosis.
  
  
  RESULTS
  The relationships between LSE and liver histology were better described using morphometry. LSE median was independently linked to fibrosis (area or FD), steatosis (area or FD), activity (serum AST), and IQR/LSE median. Steatosis area ≥4.0 % induced a 50 % increase in LSE result in patients with fibrosis area <9 %. In patients with IQR/LSE median ≤0.30, the rate of F0/1 patients misclassified as F ≥ 2 by Fibroscan was, respectively for steatosis area <4.0 and ≥4.0 %: 12.6 vs 32.4 % (p = 0.003). Steatosis level did not influence LSE median when fibrosis area was ≥9 %, and consequently did not increase the rate of F ≤ 3 patients misclassified as cirrhotic.
  
  
  CONCLUSIONS
  A precise evaluation of liver histology by computerized morphometry shows that liver stiffness measured by Fibroscan is linked to liver fibrosis, activity, and also steatosis. High level of steatosis induces misevaluation of liver fibrosis by Fibroscan.
authors.affiliation: Liver-Gastroenterology Department, University Hospital, Angers, France, JeBoursier@chu-angers.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.forename: Victor
authors.initials: V
authors.lastname: de Ledinghen
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sturm
authors.forename: Laïla
authors.initials: L
authors.lastname: Amrani
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bacq
authors.forename: Jérémy
authors.initials: J
authors.lastname: Sandrini
authors.forename: Brigitte
authors.initials: B
authors.lastname: Le Bail
authors.forename: Julien
authors.initials: J
authors.lastname: Chaigneau
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
authors.forename: Yves
authors.initials: Y
authors.lastname: Gallois
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.forename: Zaytouna
authors.initials: Z
authors.lastname: Al Hamany
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard-Hubert
authors.forename: Nina
authors.initials: N
authors.lastname: Dib
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bertrais
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rousselet
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
mesh_terms: D000328:Adult; D001706:Biopsy; D003936:Diagnosis, Computer-Assisted; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged