Role of liver biopsy in management of chronic hepatitis C: A systematic review

Gebo, Kelly A.; Herlong, H. Franklin; Torbenson, Michael; Jenckes, Mollie W.; Chander, Geetanjali; Ghanem, Khalil G.; El-Kamary, Samer S.; Sulkowski, Mark S.; Bass, Eric B

doi:10.1002/hep.1840360721

Cited by 134 publications

(100 citation statements)

References 70 publications

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“…Similar results have not been obtained with other diagnostic tests [10-17]. Since September 2002 these tests (FT-AT) have been used in several countries as an alternative to liver biopsy.…”

Section: Introductionsupporting

confidence: 70%

“…Among the non-invasive alternatives to liver biopsy [10], several studies have demonstrated the predictive value of two combinations of simple serum biochemical markers in patients infected with HCV: FibroTest (FT; Biopredictive, Paris, France; HCV-Fibrosure, Labcorp, Burlington, USA) for the assessment of fibrosis; and ActiTest (AT; Biopredictive, Paris, France) for the assessment of necroinflammatory activity (necrosis) [8,9,11-21]. Similar results have not been obtained with other diagnostic tests [10-17].…”

Section: Introductionmentioning

confidence: 99%

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Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C

et al. 2004

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BackgroundRecent studies strongly suggest that due to the limitations and risks of biopsy, as well as the improvement of the diagnostic accuracy of biochemical markers, liver biopsy should no longer be considered mandatory in patients with chronic hepatitis C. In 2001, FibroTest ActiTest (FT-AT), a panel of biochemical markers, was found to have high diagnostic value for fibrosis (FT range 0.00–1.00) and necroinflammatory histological activity (AT range 0.00–1.00). The aim was to summarize the diagnostic value of these tests from the scientific literature; to respond to frequently asked questions by performing original new analyses (including the range of diagnostic values, a comparison with other markers, the impact of genotype and viral load, and the diagnostic value in intermediate levels of injury); and to develop a system of conversion between the biochemical and biopsy estimates of liver injury.ResultsA total of 16 publications were identified. An integrated database was constructed using 1,570 individual data, to which applied analytical recommendations. The control group consisted of 300 prospectively studied blood donors. For the diagnosis of significant fibrosis by the METAVIR scoring system, the areas under the receiver operating characteristics curves (AUROC) ranged from 0.73 to 0.87. For the diagnosis of significant histological activity, the AUROCs ranged from 0.75 to 0.86. At a cut off of 0.31, the FT negative predictive value for excluding significant fibrosis (prevalence 0.31) was 91%. At a cut off of 0.36, the ActiTest negative predictive value for excluding significant necrosis (prevalence 0.41) was 85%. In three studies there was a direct comparison in the same patients of FT versus other biochemical markers, including hyaluronic acid, the Forns index, and the APRI index. All the comparisons favored FT (P < 0.05). There were no differences between the AUROCs of FT-AT according to genotype or viral load. The AUROCs of FT-AT for consecutive stages of fibrosis and grades of necrosis were the same for both moderate and extreme stages and grades. A conversion table was constructed between the continuous FT-AT values (0.00 to 1.00) and the expected semi-quantitative fibrosis stages (F0 to F4) and necrosis grades (A0 to A3).ConclusionsBased on these results, the use of the biochemical markers of liver fibrosis (FibroTest) and necrosis (ActiTest) can be recommended as an alternative to liver biopsy for the assessment of liver injury in patients with chronic hepatitis C. In clinical practice, liver biopsy should be recommended only as a second line test, i.e., in case of high risk of error of biochemical tests.

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“…Similar results have not been obtained with other diagnostic tests [10-17]. Since September 2002 these tests (FT-AT) have been used in several countries as an alternative to liver biopsy.…”

Section: Introductionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C

et al. 2004

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“…However, because of its invasiveness, liver biopsy cannot be performed frequently. In addition, there is a limitation in the accuracy of liver biopsy due to sampling error [11,12,13]. Thus, the development of noninvasive tests that are reliable, cost-effective and easy to use is required for evaluating the stage of hepatic fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Novel Image Analysis Method Using Ultrasound Elastography for Noninvasive Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis C

Fujimoto¹,

Kato

Kudo

et al. 2013

Oncology

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It has been established that the long-term infection of chronic hepatitis C leads to the increased risk of hepatic fibrosis and hepatocellular carcinoma. Currently, histological diagnosis by invasive and painful liver biopsy is the gold standard for evaluating the hepatic fibrosis stage. Because of a side effect or patient inability to cope with the pain, it is difficult to assess the fibrosis stage frequently using liver biopsy. Recently, instead of liver biopsy, many articles have been published showing the usefulness of ultrasound elastography to evaluate the stage of hepatic fibrosis. We also reported the usefulness of real-time tissue elastography (RTE) for liver fibrosis staging in 2007. However, in our previous report, fibrosis classification was performed manually and the number of patients involved was also small. In the current study, the fibrosis staging is performed automatically using software by characterizing the elastography images. We have also increased the number of patients from 64 to 310. Thus, the aim of this study is to increase objectivity by using a newly developed automatic analysis method. We obtain the Liver Fibrosis Index (LFI), which is calculated from image features of RTE images, using multiple regression analysis performed on clinical data of 310 cases as the training data set. The correlation coefficient obtained between the LFI and the stage of hepatic fibrosis was r = 0.68, and significant differences exist between all stages of fibrosis (p < 0.001). Our new method seems promising since it has the ability to diagnose fibrosis even in the presence of inflammation.

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“…According to the latest consensus conferences, liver biopsy is still recommended in most patients [2,3]. However, recent studies strongly suggest that due to the limitations [4-6] and risks of biopsy [7], as well as the improvement of the diagnostic accuracy of biochemical markers [8,9], liver biopsy should no longer be considered mandatory.…”

Section: Introductionmentioning

confidence: 99%

“…Among the non-invasive alternatives to liver biopsy [9], numerous studies have demonstrated the predictive value of two combinations of simple serum biochemical markers in patients infected with HCV and HBV: FibroTest (FT) (Biopredictive, Houilles, France) for the assessment of fibrosis, and ActiTest (AT) (Biopredictive, Houilles, France) for the assessment of necroinflammatory activity [8,12-22]. Similar results have not been obtained by other diagnostic tests [9,12-14,16-22].…”

Section: Introductionmentioning

confidence: 99%

Intra-individual fasting versuspostprandial variation of biochemical markers of liver fibrosis (FibroTest) and activity (ActiTest)

et al. 2004

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Background: Biochemical marker combinations, including α 2 -macroglobulin, haptoglobin, apolipoprotein A1, γ-glutamyl transpeptidase, and total bilirubin (all part of FibroTest) plus alanine aminotransferase (all part of ActiTest), are being developed as alternatives to liver biopsy in patients with chronic hepatitis C and other various chronic liver diseases. Considering this premise, the primary aim of this study was to assess the impact of meal intake on FibroTest and ActiTest results. Such studies are very important for patients, as many clinical errors have been related to the absence of baseline evidence.

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Role of liver biopsy in management of chronic hepatitis C: A systematic review

Cited by 134 publications

References 70 publications

Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C

Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C

Novel Image Analysis Method Using Ultrasound Elastography for Noninvasive Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis C

Intra-individual fasting versuspostprandial variation of biochemical markers of liver fibrosis (FibroTest) and activity (ActiTest)

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