Transient elastography and other noninvasive tests to assess hepatic fibrosis in patients with viral hepatitis

Abstract

The limitations of liver biopsy (invasive procedure, sampling errors, inter-observer variability and nondynamic fibrosis evaluation) have stimulated the search for noninvasive approaches for the assessment of liver fibrosis in patients with viral hepatitis. A variety of methods including the measurement of liver stiffness, using transient elastography, and serum markers, ranging from routine laboratory tests to more complex algorithms or indices combining the results of panels of markers, have been proposed. Among serum indices, Fibrotest has been the most extensively studied and validated. Transient elastography appears as a promising method but has been mostly validated in chronic hepatitis C with performance equivalent to that of serum markers for the diagnosis of significant fibrosis. The combination of both approaches as first-line assessment of liver fibrosis could avoid the performance of liver biopsy in the majority of patients with chronic hepatitis C, a strategy that deserves further evaluation in patients with hepatitis B or HIV-HCV coinfection. Transient elastography also appears to be an excellent tool for early detection of cirrhosis and may have prognostic value in this setting. Guidelines are now awaited for the use of noninvasive methods in clinical practice.

Comparison of Surrogate Serum Markers and Transient Elastography (Fibroscan) for Assessing Cirrhosis in Patients with Chronic Viral Hepatitis

“…In a recent study, it was reported that the cut-offs for cirrhosis range from 9 kPa in HBV patients to 26.5 kPa in HCV-liver transplant patients. These could be related to the lower amount of fibrosis in HBV-related cirrhosis [22]. In the subgroup analysis of our study, the AUROC for predicting cirrhosis in HBV patients was lower than that for predicting cirrhosis in HCV patients (0.678 vs 0.930, respectively), although the number of HCV patients was small (92 vs 29).…”

“…Fibroscan has been reported to be the most reliable noninvasive method for detecting cirrhosis [22,25]. But other researchers have demonstrated that the diagnostic performance of Fibroscan was similar to that of the surrogate serum marker panels [21,26].…”

“…On the other hand, a recent study showed that Fibroscan was the most accurate, noninvasive method for the early detection of cirrhosis compared with the other methods [22]. However, there are only limited studies that have compared Fibroscan with other serum marker panels.…”

Non-invasive transient elastography for the prediction of liver toxicity following hematopoietic SCT

“…5 Patients whose bilirubin exceeds 4 mg/dL in the early posttransplant period have been shown to have greatly increased …”

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

“…reason why the GSA index did not show well discriminative ability between patients with F2 and F3 is unclear, however, the small sample size in patients with F2 (n=19) may be attributed to our current results. Liver biopsy, which has been considered as the 'golden standard' for assessing the extent of liver fibrosis, carries some drawbacks: sampling error and interobserver variability, which have raised questions on its value, whereas in our present analyses, we investigated the impact of the preoperative GSA index on cirrhosis using non-tumor parts of extracted surgical specimens, which had sufficient amount of liver specimens for exact evaluation of the degree of liver fibrosis (30)(31)(32). Thus, our data are highly reliable and this is a major strength of the present study.…”