Comparison of Liver Biopsy with Transient Elastography as a Non-invasive Method for Assessment of Liver Fibrosis

Abstract

AIM: Liver biopsy (LB) – considered as the “gold standard” in evaluation of patients with chronic liver disease but it is an invasive procedure so noninvasive methods are needed to identify clinically significant fibrosis. This study was performed to compare the liver stiffness (LS) measurement by transient elastography (TE) with liver biopsy. METHODS: We performed a cross-sectional study that included a 102 consecutive patients with chronic liver disease in which LB and LS assessments (by means of TE) were performed. In all subjects, liver stiffness was measured by an experienced physician using a FibroScanR device (EchoSens, France) with standard protocol. We excluded patients for whom the successful rate (SR) of liver stiffness measurements (LSM) was < 60% and those who had measurements with an IQR >30%.LSM results were compared with liver biopsy results. RESULTS: Overall 102 patients were analyzed: 12 with HCV, 57 with HBV, 17 with Autoimmune Hepatitis and 16 cases with NASH. The median age of patients with reliable LSM was 42.8years (range 13-61).The distribution of patients in different fibrosis stages was: 0 (n=40), 1 (n=22), 2 (n=16), 3 (n=4), 4 (n=11), 5 (n=6), 6 (n=3). Fibrosis stage was significantly associated with LSM (p=0.0003). The median AST, ALT values were: 42 IU/L (15-173) and 53 IU/L (10-211) respectively. The mean LSM was 9.38±2.3 kPa (Range 2.9-65). LSM was significantly associated and concordant with stage of fibrosis. CONCLUSION: LSM in chronic liver disease patients correlates with fibrosis stages. A cut-off of 6.74 kPa can differentiate between significant fibrosis and absent or mild fibrosis, with PPV of 98%, NPV of 40.2%, sensitivity of 60.6%, specificity of 92.3%, and a diagnostic performance of 76.2%.