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Fibrosis staging in chronic hepatitis C: analysis of discordance between transient elastography and liver biopsy.

Abstract：

:In chronic hepatitis C, transient elastography (TE) accurately identifies cirrhosis, but its ability to assess significant fibrosis (Metavir > or = F2) is variable. Constitutional and liver disease-related factors may influence TE and here we examined the variables associated with differences. Three hundred consecutive hepatitis C virus (HCV)-RNA positive patients had biochemical tests, TE and a biopsy performed on the same day. The Dale model was used to identify the variables associated with discordance between biopsy and elastography results. In 97 patients (34.2%), TE and histological assessment were discordant. Seventy-six of 286 (26.6%) had stage > or =F2 and TE < 7.1 kPa (false negative); 21 of 286 (7.3%) had stage or = 7.1 kPa (false positive). No patient with discordant results had cirrhosis. By Dale model, aspartate aminotransferase (AST) was found to be the unique variable significantly related (P = 0.046) with discordance between biopsy and TE. Discordance rate was 43.4% (82 patients) with AST < 1.5 x UNL vs 25.8% (25 patients) with AST > or = 1.5 x UNL (P = 0.004). False negative rate was 43.4 (82 patients) with AST < 1.5 x UNL vs 17.1% (13 patients) with AST > or = 1.5 x UNL (P < 0.001). Areas under the receiver operating characteristic (AUROC) for F > or = 2, according to AST < 1.5 x UNL vs > or = 1.5 x UNL were 0.738 (95% CI: 0.683-0.812) and 0.854(95% CI: 0.754-0.907). Transient elastography is not adequate on its own to rule out or to rule in significant fibrosis, as it is influenced by major variations in biochemical activity of liver disease. Liver stiffness, at low levels of AST, can underestimate fibrosis.

journal_name

J Viral Hepat

journal_title

Journal of viral hepatitis

authors

Calvaruso V,Cammà C,Di Marco V,Maimone S,Bronte F,Enea M,Dardanoni V,Manousou P,Pleguezuelo M,Xirouchakis E,Attanasio M,Dusheiko G,Burroughs AK,Craxì A

doi

10.1111/j.1365-2893.2009.01199.x

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

469-74

issue

7

eissn

1352-0504

issn

1365-2893

pii

JVH1199

journal_volume

17

pub_type

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