Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C

Abstract

OBJECTIVES:Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C.METHODS:We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed.RESULTS:A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively.CONCLUSION:Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.

FIB-4 and APRI scores for predicting severe fibrosis in chronic hepatitis C - a developing country's perspective in DAA era

“…In this study FIB-4 was shown to be superior to APRI in identifying patients with severe fibrosis or cirrhosis in a setting of chronic hepatitis C (an AUC of 0.875 for FIB-4 vs an AUC of 0.861 for APRI). Other studies have come to a similar realization [12][13][14].…”

Liver fibrosis assessments using FibroScan, Virtual-Touch tissue quantification, the FIB-4 index, and Mac-2 binding protein glycosylation isomer levels compared with pathological findings of liver resection specimens in patients with hepatitis C infection

“…Many reports have compared the METAVIR scores of FibroScan and VTQ with liver biopsy, and both have been reported to be highly reliable. [12,[15][16][17][18] As mentioned previously, however, there are cases in which liver biopsy cannot provide accurate or objective results. Only a few reports have compared liver resection specimens with FibroScan, VTQ, and M2BPGi.…”

“…Many reports have compared the META-analysis of histological data in VIRal hepatitis (METAVIR) scores of those tests with liver biopsy, both of which are reported to be highly reliable. [12,[15][16][17][18] As mentioned previously, however, liver biopsy is invasive and faces limitations with respect to sample amount and pathologist subjectivity. No report has so far compared liver resection specimens in combination with VTQ, FIB-4 index and M2BPGi, and only a few reports have compared liver resection specimens with FibroScan.…”

Liver fibrosis assessments using FibroScan, Virtual-Touch tissue quantification, the FIB-4 index, and Mac-2 binding protein glycosylation isomer levels compared with pathological findings of liver resection specimens in patients with hepatitis C infection

“…As noted above, the FIB-4 index and M2BPGi level yielded relatively poor results in comparison with previous studies. [10][11][12][13] According to the ROC analyses, the sensitivity and speci city of the FIB-4 index and M2BPGi level for diagnosing brosis decreased as liver brosis progressed. However, the detection of brosis using bloodbased parameters was equivalent to that using FibroScan and VTQ for mild brosis stages.…”