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

Summary.  In chronic hepatitis C, transient elastography (TE) accurately identifies cirrhosis, but its ability to assess significant fibrosis (Metavir ≥ 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 ≥F2 and TE < 7.1 kPa (false negative); 21 of 286 (7.3%) had stage

[1]  Francesco Bartolucci,et al.  Positive Quadrant Dependence and Marginal Modeling in Two-Way Tables With Ordered Margins , 2001 .

[2]  Frank Scholle,et al.  Mitochondrial injury, oxidative stress, and antioxidant gene expression are induced by hepatitis C virus core protein. , 2002, Gastroenterology.

[3]  V. de Lédinghen,et al.  Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. , 2005, Gastroenterology.

[4]  Y. Morino,et al.  Hepatic clearance of rat liver aspartate aminotransferase isozymes: Evidence for endocytotic uptake via different binding sites on sinusoidal liver cells , 1985, Hepatology.

[5]  Eva Herrmann,et al.  Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. , 2008, Gastroenterology.

[6]  Ze-Zhou Song.  Acute viral hepatitis increases liver stiffness values measured by transient elastography , 2008, Hepatology.

[7]  T. Poynard,et al.  Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study , 2001, The Lancet.

[8]  V. de Lédinghen,et al.  Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study , 2005, Gut.

[9]  Bryan Lau,et al.  Exceeding the limits of liver histology markers. , 2009, Journal of hepatology.

[10]  Dieter Häussinger,et al.  Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage , 2007, Hepatology.

[11]  Jerold A. Cohen,et al.  The SGOT/SGPT ratio—An indicator of alcoholic liver disease , 1979, Digestive Diseases and Sciences.

[12]  M. Manns,et al.  Sustained Virologic Response and Clinical Outcomes in Patients with Chronic Hepatitis C and Advanced Fibrosis , 2007, Annals of Internal Medicine.

[13]  Dario Conte,et al.  Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease , 2007, Gut.

[14]  P. Bedossa,et al.  Intraobserver and Interobserver Variations in Liver Biopsy Interpretation in Patients with Chronic Hepatitis C , 1994 .

[15]  Laurent Castera,et al.  Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases , 2006, Hepatology.

[16]  L. Seeff,et al.  Aasld Practice Guideline Diagnosis, Management, and Treatment of Hepatitis C , 2003 .

[17]  R. Sacco,et al.  Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases , 2007, Journal of viral hepatitis.

[18]  E. Schiff,et al.  Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection , 2002, American Journal of Gastroenterology.

[19]  J. Dale.  Global cross-ratio models for bivariate, discrete, ordered responses. , 1986, Biometrics.

[20]  M. Fink,et al.  Shear elasticity probe for soft tissues with 1-D transient elastography , 2002, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[21]  J. Kalbfleisch,et al.  A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C , 2003, Hepatology.

[22]  M. Ziol,et al.  Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. , 2003, Ultrasound in medicine & biology.

[23]  Ze-Zhou Song.  Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage , 2008, Hepatology.