title: Stiffness Value and Serum Biomarkers in Liver Fibrosis Staging: Study in Large Surgical Specimens in Patients with Chronic Hepatitis B.
abstract: Purpose To investigate the capabilities of stiffness value and serum biomarkers in the staging of liver fibrosis in patients with chronic hepatitis B (CHB), with pathologic findings in large surgical specimens serving as the reference standard. Materials and Methods This study was approved by the institutional review board, and informed consent was obtained from all patients. Liver stiffness (determined by means of ultrasonography-based elastography point quantification), aspartate aminotransferase-platelet ratio index (APRI), and fibrosis index (based on the four-factor Fibrosis-4 [FIB-4] calculation) were obtained in 386 patients with CHB. With pathologic fibrosis stages in large surgical specimens as the reference standard, capabilities and cutoffs of stiffness and serum biomarkers were first investigated in a cohort of 284 patients and then validated in an independent cohort of 102 patients by means of area under the receiver operating characteristic curve (AUC) analysis. Results Liver stiffness demonstrated significantly stronger correlation with fibrosis stages than did APRI and FIB-4 (r = 0.738 vs r = 0.477 vs r = 0.427, respectively; P < .05 for all). In the development cohort, liver stiffness had significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.97, 0.96, 0.91, and 0.87, respectively) than APRI (0.89, 0.84, 0.73, and 0.74, respectively) and FIB-4 (0.82, 0.79, 0.70, and 0.72, respectively). In the validation cohort, liver stiffness was validated as showing significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.99, 0.95, 0.89, and 0.88, respectively) than APRI (0.83, 0.76, 0.78, and 0.68, respectively) and FIB-4 (0.76, 0.69, 0.75, and 0.67, respectively). Conclusion Liver stiffness demonstrated considerable capability in identifying each stage of liver fibrosis in patients with CHB, whereas serum biomarkers showed limited capabilities. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lu
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Changli
authors.initials: C
authors.lastname: Lu
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Jiawu
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Wenwu
authors.initials: W
authors.lastname: Ling
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Qi
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Du
authors.initials: D
authors.lastname: He
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Jianping
authors.initials: J
authors.lastname: Liu
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Tianfu
authors.initials: T
authors.lastname: Wen
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Hongguang
authors.initials: H
authors.lastname: Zhu
authors.affiliation: From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000097:blood* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers