Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C

Authors

  • Taisa Grotta Ragazzo Universidade de São Paulo; Hospital das Clinicas HCFMUSP, Faculdade de Medicina; Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia
  • Denise Paranagua-Vezozzo Universidade de São Paulo; Hospital das Clinicas HCFMUSP, Faculdade de Medicina; Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia
  • Fabiana Roberto Lima Universidade Estadual de Campinas; Faculdade de Ciencias Medicas; Divisao de Gastroenterologia
  • Daniel Ferraz de Campos Mazo Universidade Estadual de Campinas; Faculdade de Ciencias Medicas; Divisao de Gastroenterologia
  • Mário Guimarães Pessoa Universidade de São Paulo; Hospital das Clinicas HCFMUSP, Faculdade de Medicina; Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia
  • Claudia Pinto Oliveira Universidade de São Paulo; Hospital das Clinicas HCFMUSP, Faculdade de Medicina; Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia
  • Venancio Avancini Ferreira Alves Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Patologia
  • Flair José Carrilho Universidade de São Paulo; Hospital das Clinicas HCFMUSP, Faculdade de Medicina; Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia

DOI:

https://doi.org/10.6061/clinics/2017(09)01

Keywords:

Hepatitis C Chronic, Liver Cirrhosis, Elastography, Biomarkers/Blood, Disease Progression, Data Accuracy

Abstract

OBJECTIVES: Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C. METHODS: We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed. RESULTS: A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively. CONCLUSION: Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.

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Published

2017-10-01

Issue

Section

Clinical Sciences

How to Cite

Ragazzo, T. G., Paranagua-Vezozzo, D., Lima, F. R., de Campos Mazo, D. F., Pessoa, M. G., Oliveira, C. P., Alves, V. A. F., & Carrilho, F. J. (2017). Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C. Clinics, 72(9), 516-525. https://doi.org/10.6061/clinics/2017(09)01