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

Gebo, M.P.H. 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:10.1053/jhep.2002.36989

Cited by 138 publications

(73 citation statements)

References 73 publications

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“…Clinically significant fibrosis is generally defined by a fibrosis stage of F2 or higher, as patients with fibrosis stage F2 are at an increased risk for developing cirrhosis along with its complications including ascites, encephalopathy, or portal hypertension (21,33). In addition, advanced fibrosis or cirrhosis (F3 or F4) is associated with a decreased likelihood of sustained response to treatment (25,34,35). As our study showed that MRE was more accurate than APRI in detecting significant fibrosis, severe fibrosis, and cirrhosis, MRE may be helpful in predicting the prognosis and determining the optimal treatment plan.…”

Section: Discussionmentioning

confidence: 99%

MR elastography for noninvasive assessment of hepatic fibrosis: Experience from a tertiary center in asia

Kim

Lee

et al. 2011

Magnetic Resonance Imaging

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Purpose: To determine the sensitivity and specificity of MR elastography (MRE) in the staging of hepatic fibrosis (HF) using histopathology as the reference standard in an Asian population.Materials and Methods: MRE was performed on 55 patients with chronic liver diseases or biliary diseases and on 5 living related liver donors (48 men and 12 women; mean age, 55.7 years). MRE was performed with modified, phase-contrast, gradient-echo sequences, and the mean stiffness values were measured on the elastograms in kilopascals(kPa). Receiver operating characteristic curve analysis was performed to determine the cutoff value and accuracy of MRE for staging HF. Histopathologic staging of HF according to the METAVIR scoring system served as the reference.Results: Liver stiffness increased systematically along with the fibrosis stage. With a shear stiffness cutoff value of 3.05 kPa, the predicted sensitivity and specificity for differentiating significant liver fibrosis (! F2) from mild fibrosis (F1) were 89.7% and 87.1%, respectively. In addition, MRE was able to discriminate between patients with severe fibrosis (F3) and those with liver cirrhosis (sensitivity, 100%; specificity, 92.2%), with a shear stiffness cutoff value of 5.32 kPa.Conclusion: MRE could be a promising, noninvasive technique with excellent diagnostic accuracy for detecting significant HF and liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

MR elastography for noninvasive assessment of hepatic fibrosis: Experience from a tertiary center in asia

Kim

Lee

et al. 2011

Magnetic Resonance Imaging

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“…Liver biopsy is the gold standard method for histological evaluation of liver fibrosis [13] . Although a liver biopsy is generally a safe procedure, it is costly, invasive and has a small risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Although a liver biopsy is generally a safe procedure, it is costly, invasive and has a small risk of complications. In addition, only 1/50 000 of the organ is removed and there can be sampling errors [13] . Furthermore, it has also been reported that there are inter-and intra-observer discrepancies of 10% to 20% [14,15] .…”

Section: Discussionmentioning

confidence: 99%

Elevation of the glycated albumin to glycated hemoglobin ratio during the progression of hepatitis C virus related liver fibrosis

Aizawa¹,

Enomoto²,

Imanishi³

et al. 2012

WJH

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AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis. METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant difference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%, respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%). CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis

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“…A major clinical challenge is to find the best method to evaluate and to manage the increasing numbers of patients with chronic liver disease [1][2][3][4] . Liver biopsy, due to its risks and limitations, is no longer considered mandatory as the first-line indicator of liver injury, and several markers have been developed as non-invasive alternatives [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

“…Liver biopsy, due to its risks and limitations, is no longer considered mandatory as the first-line indicator of liver injury, and several markers have been developed as non-invasive alternatives [1][2][3][4] . The assessment of liver fibrosis by non-invasive techniques such as biomarkers, [FibroTest ® (FT)] [5] and liver stiffness measurement (LSM) by Fibroscan ® [6,7] , is now widely performed in countries where these techniques are available and approved [8,9] .…”

Section: Introductionmentioning

confidence: 99%

Applicability and variability of liver stiffness measurements according to probe position

Ingiliz¹,

Chhay²,

Munteanu³

et al. 2009

WJG

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AIM:To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS:The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest. RESULTS:Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a significant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03). CONCLUSION:The anterior position of the probe should be the first choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position. INTRODUCTIONA major clinical challenge is to find the best method to evaluate and to manage the increasing numbers of patients with chronic liver disease [1][2][3][4] . Liver biopsy, due to its risks and limitations, is no longer considered mandatory as the first-line indicator of liver injury, and several markers have been developed as non-invasive alternatives [1][2][3][4] . The assessment of liver fibrosis by non-invasive techniques such as biomarkers, [FibroTest ® (FT)] [5] and liver stiffness measurement (LSM) by Fibroscan ® [6,7] , is now widely performed in countries where these techniques are available and approved [8,9] . It is therefore essential to identify factors associated with a variability of the results of these techniques to reduce the risk of false positives or false negatives. There are no published procedures for the most accurate position of the probe in LSM. In almost all [6,7,[9][10][11][12][13][14][15][16] , the described method is copied from the original description by Sandrin et al [13] : "Because liver biopsies are performed on the right lobe of the liver, so were the elasticity measurements. During the acquisition, patients were lying on their backs with their right arms behind their heads. The physician first proceeded to a sonographic examination to localize the best ultrasonic imaging window between the rib bones. Additionally, regions with large vessels were avoided and a minimal liver parenchyma thickness of 6 cm was sought".Few studies have examined the variability possibly associated with different positions in the rather vaguely defined area called "the liver biopsy zone". The variability associated with position could be part of the interobserver effect. Only two published studies have ...

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

Cited by 138 publications

References 73 publications

MR elastography for noninvasive assessment of hepatic fibrosis: Experience from a tertiary center in asia

MR elastography for noninvasive assessment of hepatic fibrosis: Experience from a tertiary center in asia

Elevation of the glycated albumin to glycated hemoglobin ratio during the progression of hepatitis C virus related liver fibrosis

Applicability and variability of liver stiffness measurements according to probe position

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