Research ArticleReliability of transient elastography for the detection of fibrosis in Non-Alcoholic Fatty Liver Disease and chronic viral hepatitis
Introduction
The prognosis of hepatic liver diseases as well as the success of specific treatments depends on the extent of liver fibrosis. Liver biopsy (LB) is still considered the “gold standard” to evaluate liver damage. Although generally safe, this procedure is invasive and the risk/benefit ratio is seldom uncertain, or patients may not accept the discomfort related to the procedure [1], [2]. The accuracy of LB in assessing fibrosis varies depending on inter-observer variability and on sampling error, resulting in up to 30% false negative results and underestimation of cirrhosis, especially for small or fragmented specimens [3], [4], [5], [6], [7].
In the last few years, non-invasive tests that reflect the full spectrum of liver fibrosis have been developed [8], [9], [10], [11]. Transient elastography (TE, Fibroscan, Echosens, Paris, France) is a non-invasive device which measures liver stiffness, as a function of the extent of hepatic fibrosis [12], [13]. Liver stiffness measurement (LSM) appears to be a reliable tool to identify hepatic fibrosis and cirrhosis mainly in patients with chronic hepatitis C (CHC) [12], [14], [15], [16], [17] but limited data are available in patients with chronic hepatitis B (CHB) [18], [19] or Non-Alcoholic Fatty Liver Disease (NAFLD) [20], [21], [22]. The cirrhosis of patients with CHB is often macro nodular and may display a reduced amount of fibrosis compared to micro nodular cirrhosis, thus leading to an underestimation of LSM. In NAFLD patients, various degrees of hepatic steatosis may attenuate the elastic shear wave, possibly leading again to an underestimation of liver damage.
The aims of this prospective study were to assess the accuracy and the efficacy of TE for the detection of fibrosis in patients with liver disease of different etiology (CHC, CHB, and NAFLD) and to evaluate the effect of steatosis on liver stiffness measurements.
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Study subjects
Between January 2007 and March 2009, all patients with viral or metabolic chronic liver disease, who underwent liver biopsy at the Hepatology Unit in San Giovanni Battista Hospital, were prospectively enrolled. Diagnosis of chronic liver disease was made by standard criteria. Chronic hepatitis B (CHB) was defined by the presence of Hepatitis B surface antigen and core antibody with detectable HBV DNA at PCR analysis. Chronic hepatitis C (CHC) was defined by detectable anti-hepatitis C virus
Clinical, biochemical, and histological data
A total of 290 patients were initially enrolled in the study. Twenty-one patients (8%) were excluded because of unsuccessful liver stiffness measurements (less than 10 valid measurements and/or a success rate lower the 60%), due to obesity and thickness of the thoracic wall (>2 cm). Ten more cases were excluded because LB specimens were shorter than 20 mm (n = 7) or diagnosis was uncertain (n = 3). Analysis was carried out in 259 subjects. Seventy-seven had a diagnosis of CHC, 70 of CHB, 72 of NAFLD,
Discussion
We herein report a single center experience for the surrogate assessment of fibrosis by Fibroscan in a cohort of patients according to the etiology of chronic liver disease. In order to analyze the accuracy of TE in hepatitis B and NAFLD in comparison with the standard hepatitis C, we sought to exclude factors known to affect TE measurement. Patients with acute liver disease, acute reactivation on chronic liver damage, or alcohol abuse were excluded to avoid influence of acute
Conflict of interest
The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
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