Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study

Seo, Yeon Seok; Kim, Moon Young; Kim, Seung Up; Hyun, Bae Si; Jang, Jae Young; Lee, Jin Woo; Lee, Jung Il; Suh, Sang Jun; Park, Soo Young; Park, Hana; Jung, Eunjin; Kim, Byung Seok; Kim, In Hee; Lee, Tae Hee; Um, Soon Ho; Han, Kwang‐Hyub; Kim, Sang Gyune; Paik, Soon Koo; Choi, Jong Young; Jeong, Soung Won; Jin, Yoonhee; Lee, Kwan Sik; Yim, Hyung Joon; Tak, Won Young; Hwang, Seong Gyu; Lee, Youn Jae; Lee, Chang Hyeong; Kim, Dae‐Ghon; Kang, Young Woo; Kim, Young Seok

doi:10.1111/liv.12808

Cited by 71 publications

(68 citation statements)

References 45 publications

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“…However, histological assessment was not selected as an independent predictor of HCC and LRE development when adjusted with and without LS value. In contrast, it was demonstrated that TE could assess the fibrotic burden with acceptable accuracy (AUC more than 0.8 for each fibrosis stage) similar to a vast amount of previous studies, 13,19,25 and that TE was independently prognostic in predicting HCC and LRE development even after adjusting for LB and other variables. These findings support the necessity to check LS values at the time of starting antiviral therapy.…”

Section: Discussionsupporting

confidence: 69%

Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy

Seo¹,

Kim

et al. 2016

Medicine

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Liver stiffness (LS) assessed using transient elastography (TE) can assess the risk of developing hepatocellular carcinoma (HCC). We evaluated whether TE, when compared with histological data as a reference standard, can predict the risk of HCC development in chronic hepatitis B (CHB) patients starting antiviral therapy.Observational cohort database of 381 patients with CHB who underwent liver biopsy (LB) and TE were reviewed. All patients underwent surveillance for HCC development using ultrasonography and alpha-fetoprotein.During the median follow-up period of 48.1 (interquartile range 30.3–69.3) months, HCC developed in 34 (8.9%) patients. In patients with HCC development, age, proportion of diabetes mellitus, histological fibrosis stage, and LS value were significantly higher than those in patients without (all P <0.05). The cumulative incidence rates of HCC increased significantly in association with elevated LS value in 3 stratified groups (LS value <8, 8–13, and >13 kPa; log-rank test, P <0.001), and with higher histological fibrosis stage in 3 stratified groups (F0–2, F3, and F4; log-rank test, P <0.001). On multivariate analysis, along with age, LS value was an independent predictor of HCC development (hazard ratio 1.041, P <0.001), whereas histological staging was not (P >0.05).TE predicted HCC development independently in patients with CHB starting antiviral therapy. However, further investigation is needed to determine whether the current surveillance strategy can be optimized based on the LS value at the time of starting antiviral therapy.

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Section: Discussionsupporting

confidence: 69%

Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy

Seo¹,

Kim

et al. 2016

Medicine

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“…20,22,23,31–34 In our cross-sectional analysis, LS value showed accuracy similar to that encountered in prior studies (AUC: 0.823–0.848), 23,35 suggesting that even with the limited size of this cohort, patient characteristics were appropriate for evaluating WFA + -M2BP as well. However, the diagnostic accuracy of WFA + -M2BP (AUC ∼0.7) proved unsatisfactory, compared with other studies (AUC >0.8).…”

Section: Discussionsupporting

confidence: 84%

“…Furthermore, longitudinal analysis of LS indicated only borderline statistical significance in assessing the risk of developing HCC ( P = .065), despite notable similarity to previous TE-based investigations (AUC >0.8). 23,35 Given that LS value is a known factor in predicting the risk of HCC, 21,31,32 this seemingly inconsistent outcome may be related to the limited sampling. Sample size was also inadequate to systematically control relevant variables, such as antiviral agent use, existing cirrhosis, and necroinflammatory activity, for subgroup analyses, even though the appropriate adjustments were made in multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

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Use of Wisteria Floribunda Agglutinin-Positive Human Mac-2 Binding Protein in Assessing Risk of Hepatocellular Carcinoma Due to Hepatitis B Virus

Heo

Kim²,

Park

et al. 2016

Medicine

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Wisteria floribunda agglutinin-positive human Mac-2 binding protein (WFA+-M2BP) is a serologic marker corresponding with degree of hepatic fibrosis. We evaluated its accuracy in assessing hepatic fibrosis and in predicting the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).In a 5-year period (2009–2013), a total of 95 CHB patients with available serum WFA+-M2BP assay and transient elastography assessment [to assess liver stiffness (LS)] who had undergone liver biopsy were recruited for retrospective analysis.Areas under the receiver operating characteristic curve for predicting fibrosis stages via serum WFA+-M2BP level were as follows: ≥F2, 0.688; ≥F3, 0.694; and F4, 0.704 (all P < 0.05). During the follow-up period (median, 45 months), HCC developed in 7 patients (7.4%). In patients with HCC, age, use of antiviral therapy, test parameters (HBV DNA, WFA+-M2BP, and LS determinations), and histologic stage of fibrosis were all significantly greater than in those free of HCC, whereas platelet count was significantly lower (all P < 0.05). On multivariate analysis, WFA+-M2BP was found independently predictive of emergent HCC [hazard ratio (HR) = 2.375; P = 0.036], although LS and histologic stage of fibrosis were not (P > 0.05). Risk of developing HCC was significantly greater in patients with high WFA+-M2BP levels (≥1.8) (adjusted HR = 11.5; P = 0.025). Cumulative incidence rates of HCC were also significantly higher in patients with high (vs. low) levels of WFA+-M2BP (log-rank test, P = 0.016).WFA+-M2BP determination significantly reflected degree/extent of hepatic fibrosis and independently predicted the risk of developing HCC in patients with CHB.

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“…As a liver biopsy only samples approximately 1/50000 of the liver, there have been concerns with sampling errors despite an adequate number of portal tracts and sample size[7,10,11]. Intra- and inter-observer variation in histological interpretation has also been reported[12,13]. Given these limitations, much research has been dedicated to evaluating non-invasive methods to determine liver fibrosis[5,9].…”

Section: Introductionmentioning

confidence: 99%

Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis

Wong

Huynh

Zhang

2017

WJH

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AIMTo evaluate the performance of aspartate aminotransferase to platelet ratio (APRI) score against FibroScan in predicting the presence of fibrosis.METHODSData of patients who concurrently had APRI score, FibroScan and liver biopsy to assess their hepatitis C virus (HCV) and hepatitis B virus (HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3.RESULTSOf the 3619 patients (47.5 ± 11.3 years, 97M:36F) who had FibroScans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133 (20%, F3 = 21 and F4 = 6) patients. Although APRI score (P < 0.001, AUC = 0.83) and FibroScan (P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest (APRI score: 51.9% sensitivity, 84.9% specificity; FibroScan: 63% sensitivity, 84% specificity). Whilst 13/27 (48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with 100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroScan in 43% of patients.CONCLUSIONAPRI score and FibroScan performed equally well in predicting advanced fibrosis. A proposed APRI cut-off score of 0.5 could be used as a screening tool for FibroScan, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.

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Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study

Abstract: TE can accurately assess the degree of liver fibrosis in Korean patients with CVH. TE was superior to APRI for predicting each fibrosis stage.

Cited by 71 publications

References 45 publications

Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy

Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy

Use of Wisteria Floribunda Agglutinin-Positive Human Mac-2 Binding Protein in Assessing Risk of Hepatocellular Carcinoma Due to Hepatitis B Virus

Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis

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