Transient Elastography (Fibroscan) in Patients with Chronic Hepatitis B

Abstract

AIM: To evaluate the efficacy of transient elastography (TE) in liver fibrosis assessment in chronic hepatitis B (CHB) patients.

METHODS: Patients from two Greek referral centers were included. All patients were antiHBe (+) and underwent liver biopsy (LB) and liver stiffness measurements (LSM) within a 6-month maximum interval. LB had at least 1.5 cm length and was evaluated using the Ishak scoring system by two experienced liver pathologists. Unreliable LSM was defined as an interquantile range (IQR)/LSM >0.3 and/or a success rate (SR) <60%. LSM operators had adequate experience (>100, <500 examinations).

RESULTS: 79 patients were analyzed. LSM was considered unreliable in 20/79 (25.3%). Patients with unreliable LSM tended to be older (54 vs. 47 years, p=0.08) and heavier - as measured by body mass index - (27.1 vs. 24.6, p=0.08) as compared to those with reliable LSM. The median age of patients with reliable LSM was 47 years (range 22-71). 74% were male and the mean BMI was 25.2±3.2. The median AST, ALT and HBV-DNA values were: 30 IU/L (12-300); 42 IU/L (13-360); 8.4×103 IU/ml (0-2×109), respectively. The distribution of patients in different fibrosis stages was: 0 (n=7), 1 (n=18), 2 (n=17), 3 (n=7), 4 (n=5), 5 (n=2), 6 (n=3). Fibrosis stage was significantly associated with LSM (r=0.46, p=0.0002). In addition, LSM was associated with AST and ALT levels (r=0.38, p=0.01; r=0.32, p=0.03, respectively) and male gender as compared to female (6.7 vs. 5.2, p=0.04). The area under receiver-operating characteristic curves were 0.74 for stage≥3, 0.85 for≥4, 0.87 for≥5 and 0.86 for stage=6. For stage≥5, the optimal LSM cut-off value was 7.7 kPa by maximizing the sum of sensitivity and specificity (positive predictive value: 26.3%, negative predictive value: 100%).

CONCLUSION: LSM in CHB patients correlates well with fibrosis stages. The cut-off of 7.7 kPa can exclude cirrhosis offering a useful tool for assessing these patients.