Head-to-Head Comparison between Collagen Proportionate Area and Acoustic Radiation Force Impulse Elastography in Liver Fibrosis Quantification in Chronic Hepatitis C

Abstract

BackgroundThe aim of this study was to compare the diagnostic performances of the collagen proportionate area (CPA) and liver stiffness measurement (LSM) for liver fibrosis quantification in chronic hepatitis C (CHC).MethodsA total of 137 eligible consecutive Taiwanese patients (74 women and 63 men; age 21–80 years; median age 54 years), with CHC underwent LSM by using acoustic radiation force impulse (ARFI) elastography and an immediate percutaneous liver biopsy for METAVIR scoring. Liver tissue sections were stained using picrosirius red. Areas of the stained collagen and the tissue parenchyma were calculated in pixels. The ratio between the two areas was expressed as a CPA percentage. The result of LSM was presented as shear wave velocity (SWV).ResultsMETAVIR fibrosis (F) stages were dichotomized using the CPA (%) and SWV (m/s), and the optimal cut-off values were 7.47 and 1.59 for F1 versus F2–4; 12.56 and 1.73 for F1, 2 versus F3, 4; 15.32 and 1.96 for F1–3 versus F4. To dichotomize F1 versus F2–4, the areas under receiver operating characteristic curves for the CPA was 0.9349 (95% confidence interval: 0.8943–0.9755) and for SWV was 0.8434 (0.7762–0.9105) (CPA versus SWV, P = 0.0063). For F1, 2 versus F3, 4, the CPA was 0.9436 (0.9091–0.9781); SWV was 0.8997 (0.8444–0.9551) (P = 0.1587). For F1–3 versus F4, the CPA was 0.8647 (0.7944–0.9349); SWV was 0.9036 (0.8499–0.9573) (P = 0.2585). The CPA could be predicted in a linear regression formula by using SWV and platelet count (R2 = 0.524).ConclusionsThe CPA and ARFI elastography are promising tools for liver fibrosis evaluation. The CPA was superior to ARFI elastography in the diagnosis of significant fibrosis (≥ F2). The CPA may be independent of severe necroinflammation, which may augment liver stiffness.

Comparison of collagen proportionate areas in liver fibrosis quantification between chronic hepatitis B and C

“…In the CHC group, [28] the Spearman rank correlation coefficient between the CPA and METAVIR F stages was 0.819 ( P  < 0.001); between the PBPA and METAVIR F, the coefficient was 0.817 ( P  < 0.001); and between the PSPA and METAVIR F, it was −0.618 ( P  < 0.001). The Spearman rank correlation coefficient between the CPA and SWV was 0.706 ( P  < 0.001); between the PBPA and SWV, the coefficient was 0.704 ( P  < 0.001); and between the PSPA and SWV, it was −0.521 ( P   0.001).…”

Quantification of Liver Fibrosis—A Comparative Study

“…In Marino et al [40], a total of 101 HCV patients with early biopsy (< 6 months) and HVPG measurements one year after LT were included. Chen et al [41] included a total of 137 patients diagnosed with CHC, who participated in a cohort for the analysis of antiviral treatment responses.…”

“…Marino et al [40], chose the CPA to detect the expansion of fibrosis at the very early stages after liver transplantation. Based on this preference, their work aimed to evaluate whether sinusoidal fibrosis (SF) in early liver biopsies represents an early and accurate marker for identifying patients with severe HCV recurrence after LT. For Chen et al [41], their goal was to compare the diagnostic performances of CPA and LSM in chronic hepatitis C biopsy specimens. This comparison would determine the liver fibrosis quantification by using the CPA and would in parallel focus on the necroinflammatory effects of liver stiffness (LS).…”

“…For Marino et al [40], two-micron sections were stained with H&E and Masson's trichrome for evaluation by an expert pathologist, while samples for the assessment of sinusoidal fibrosis (SF) and collagen types I and III were stained in SR. Chen et al [41] applied the MT, H&E, and reticulin stains Even though Sirius red is known to be one of the best techniques for the quantitative determination of collagen in liver fibrosis, more and more studies rely on Masson's trichrome ( Figure 6), as it is currently regarded as the gold standard for biopsy tissue coloring. Published research works [34,36,37,55] have conducted experiments on MT colored samples because this staining method is available in most pathology laboratories and an optimal contrast can be obtained between the blue stained fibrous tissue and the red parenchyma.…”

“…For Marino et al [40], two-micron sections were stained with H&E and Masson's trichrome for evaluation by an expert pathologist, while samples for the assessment of sinusoidal fibrosis (SF) and collagen types I and III were stained in SR. Chen et al [41] applied the MT, H&E, and reticulin stains in specimens for interpretation by an experienced pathologist blinded to the LSM results. On the other hand, selected liver tissue sections were stained using picro-Sirius red for measuring the CPA.…”