title: Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B.
abstract: BACKGROUND
  The accuracy of Enhanced Liver Fibrosis (ELF; ADVIA Centaur, Siemens Healthcare Diagnostics, Tarrytown, NY, USA) in assessing liver fibrosis in chronic hepatitis B (CHB) is to be determined.
  
  
  OBJECTIVE
  To derive and validate a combined ELF-liver stiffness measurement (LSM) algorithm to predict advanced fibrosis in CHB patients.
  
  
  METHODS
  Using the data of a previously reported cohort of 238 CHB patients, an ALT-based LSM algorithm for liver fibrosis was used as a training cohort to evaluate the performance of ELF against liver histology. The best combined ELF-LSM algorithm was then validated in new cohort of 85 CHB patients not previously reported.
  
  
  RESULTS
  In the training cohort, LSM has better performance of diagnosing advanced (≥F3) fibrosis (area under the receiver operating characteristics curve [AUROC] 0.83, 95% confidence interval [CI 0.76-0.91] than ELF (AUROC 0.69, 95% CI 0.63-0.75). The optimal cut-off values of ELF were 8.4 to exclude advanced fibrosis, and 10.8 to confirm advanced fibrosis. In the training cohort, an ELF ≤ 8.4 had a sensitivity of 95% to exclude advanced fibrosis; an ELF > 10.8 had a specificity of 92% to confirm advanced fibrosis. In the combined algorithm, low ELF or low LSM could be used to exclude advanced fibrosis as both of them had high sensitivity (≥90%). To confirm advanced fibrosis, agreement between high ELF and high LSM could improve the negative predictive value specificity (from 65% and 74% to 80%).
  
  
  CONCLUSIONS
  An Enhanced Liver Fibrosis - liver stiffness measurement algorithm could improve the accuracy of prediction of either ELF or LSM alone. Liver biopsy could be correctly avoided in approximately 60% of patients.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: G L-H
authors.initials: GL
authors.lastname: Wong
authors.forename: H L-Y
authors.initials: HL
authors.lastname: Chan
authors.forename: P C-L
authors.initials: PC
authors.lastname: Choi
authors.forename: A W-H
authors.initials: AW
authors.lastname: Chan
authors.forename: Z
authors.initials: Z
authors.lastname: Yu
authors.forename: J W-Y
authors.initials: JW
authors.lastname: Lai
authors.forename: H-Y
authors.initials: HY
authors.lastname: Chan
authors.forename: V W-S
authors.initials: VW
authors.lastname: Wong
mesh_terms: D000328:Adult; D000465:Algorithms; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve