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FIBROSCAN, MONITORING LIVER STIFFNESS: A NEW TOOL TO
MEASURE LIVER FIBROSIS DURING THERAPY
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Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
Barbara Coco, U.O.Gastroenterologia ed Epatologia - AOU Pisana, Pisa, Italy;
Filippo Oliveri, Piero Colombatto, Pietro Ciccorossi, Rodolfo Sacco, U.O. Gastroenterologia ed Epatologia - AOU pisana, Pisa, Italy; Ferruccio Bonino, Direzione Scientifica - Ospedale Maggiore IRCCS, Milano, Italy; Maurizia R. Brunetto, U.O. Gastroenterologia ed Epatologia - AOU pisana, Pisa, Italy
Hepatic fibrosis is the major indicator of progressive liver disease. However histology, the gold standard tool to detect fibrosis, requires an invasive procedure, that is unsuitable for monitoring disease progression and may be affected by sampling errors.
Our aims were: 1. to evaluate the diagnostic accuracy (DA) of liver stiffness by FIBROSCAN (Echosens, Paris, France) for detection of liver fibrosis and cirrhosis in patients (pts) with viral (HBV and HCV) chronic hepatitis; 2. to compare the DA of Fibroscan (FS) to other scores and surrogate markers of fibrosis: APRI and Forns scores, Fibrotest (FT) and Hyaluronic acid (HA).
We evaluated 241 consecutive pts with a liver biopsy performed within 12 months from FS (159 pts) or with ultrasound signs of cirrhosis (Child A, 69 pts). Histological staging were scored according to METAVIR.
228 pts were suitable for the analysis: 7 pts were excluded for liver biopsy not adequate to stage fibrosis and 6 for technical limitations to FS. Stiffness mean values significantly correlated with fibrosis score: 6.3; 9.1; 20.8; 25.6 KPa for fibrosis F0-F1; F2-F3; F4 and clinical cirrhosis, respectively (p <0.001). By a ROC analysis we found that, in overall pts, FS values >/= 8.3 KPa identified
fibrosis >/= F2 with 88.5% sensitivity and 74% specificity (DA 83%), whereas values >/= 14 KPa detected cirrhosis with 78.3% sensitivity and 98.2% specificity (DA 88.2%).
The DA of FS for detection of cirrhosis was higher (91.2%) considering only the 159 pts with liver biopsy. We observed as among cirrhotic pts, those with spontaneous or IFN/antiviral induced prolonged biochemical remission had FS values significantly lower than those with disease activity (mean 14.9 vs 25.6 KPa, p 0.001) and frequently lower than 14 KPa (52% vs 13.3% pts). FS had a better AUROCs than APRI and Forns scores (0,948 vs 0,813 and 0,901 respectively). FS showed an higher DA than FT and HA to identify both fibrosis
>/= F2 (83.8% vs 73.9% and 77.5% respectively) and cirrhosis (86% vs 73.2% and 75.6% respectively).
Combination with FT and HA did not improve the performance of FS, except in pts with disease remission (45 % sensitivity for FS vs 80% when using the 3 tests, with at least 1 positive).
Conclusions: Liver stiffness measured by FS significantly correlates with fibrosis at histology. Lower stiffness values in pts with biochemical remission prompt its clinical usefulness to monitor treatment efficacy. In our cohort FS showed an higher DA compared to other scores and surrogate markers of liver fibrosis.
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