Liver Stiffness Measurement Versus Clinicians' Prediction or Both for the Assess

December 2, 2006

Liver Stiffness Measurement Versus Clinicians' Prediction or Both for the

Assessment of Liver Fibrosis in Patients with Chronic Hepatitis C

Authors: Nahon, Pierre1; Thabut, 2; Ziol, nne3; Tin-Tin Htar,

Myint1; Cesaro, Fabien1; Barget, Nathalie1; Grando-Lemaire, Véronique1;

Ganne-, Nathalie1; Trinchet, Jean-Claude1; Beaugrand, Michel1

Source: The American Journal of Gastroenterology, Volume 101, Number 12,

December 2006, pp. 2744-2751(8)

Publisher: Blackwell Publishing

Abstract:

OBJECTIVES: & #8195;The goal of this study was to estimate the additional

value of liver stiffness measurement (LSM) with physicians' assessment of

fibrosis based on epidemiological, clinical, and biological parameters.

METHODS: & #8195;One hundred forty-two unselected patients with chronic

hepatitis C were included. Liver biopsy and LSM were performed

simultaneously. First, four physicians (two junior residents with limited

experience in hepatology and two senior hepatologists) independently

predicted the stage of fibrosis according to the METAVIR classification,

using clinical, epidemiological, and biological data. For the second step,

they were informed of LSM values and could modify their first evaluation if

necessary. Finally, the two successive evaluations were compared with the

histological fibrosis score.

RESULTS: & #8195;Providing LSM values improved agreement between physicians

and resulted in a better correlation between clinical impression and

histological liver fibrosis. The diagnostic performances were only

significantly improved with transient elastography for the diagnosis of

cirrhosis where assessment improved in three of the four physicians (AUROC

[area under receiver operating characteristic curve]: 0.76 vs 0.87, 0.80 vs

0.87, and 0.83 vs 0.89, all p < 0.05). Moreover, these performances were

nearly similar for junior and senior physicians when LSM was provided with

the AUROC ranging from 0.69 to 0.72 for significant fibrosis and 0.87 to

0.90 for cirrhosis.

CONCLUSIONS: & #8195;Providing LSM values to physicians results in a better

estimation of liver fibrosis and a more accurate diagnosis of cirrhosis.

Moreover, it allows physicians with limited experience to predict liver

fibrosis as well as experienced hepatologists.

(Am J Gastroenterol 2006;101:2744-2751)

Document Type: Research article

DOI: 10.1111/j.1572-0241.2006.00816.x

Affiliations: 1: Service d'Hépato-gastroentérologie, Hôpital Verdier,

AP-HP, Bondy, France et UPRES 3409, UFR SMBH, Université Paris XIII,

Bobigny, France 2: Département d'Epidemiologie, Biostatistique et Recherche

Clinique, Groupe Hospitalier Bichat Claude Bernard, APHP, Paris, France 3:

Service d'Anatomopathologie, Hôpital Verdier, AP-HP, Bondy, France et

UPRES 3408, UFR SMBH, Université Paris XIII, Bobigny, France

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December 2, 2006