|
Should
Liver Biopsy Be Recommended Only as a Second Line Test in
Chronic Hepatitis C Patients?
Recent studies strongly
suggest that due to the limitations and risks of biopsy, as
well as the improvement of the diagnostic accuracy of biochemical
markers, liver
biopsy
should no longer be considered mandatory in patients with
chronic hepatitis C.
In 2001, FibroTest
ActiTest (FT-AT), a panel of biochemical
markers, was found to have high diagnostic value for fibrosis (FT range 0.00–1.00) and
necroinflammatory histological activity (AT range 0.00–1.00).
The aim of the current study was to summarize the diagnostic
value of these tests from the scientific literature; to respond
to frequently asked questions by performing original new analyses
(including the range of diagnostic values, a comparison with
other markers, the impact of genotype and viral load, and the
diagnostic value in intermediate levels of injury); and to
develop a system of conversion between the biochemical and
biopsy estimates of liver injury.
Results
· A
total of 16 publications were identified.
· An
integrated database was constructed using 1,570 individual
data, to which applied analytical recommendations. T
· The
control group consisted of 300 prospectively studied blood
donors.
· For
the diagnosis of significant fibrosis by the METAVIR scoring
system, the areas under the receiver operating characteristics
curves (AUROC) ranged from 0.73 to 0.87.
·
For
the diagnosis of significant histological activity, the AUROCs
ranged from 0.75 to 0.86.
· At
a cut off of 0.31, the FT negative predictive value for excluding
significant fibrosis (prevalence 0.31) was 91%.
· At
a cut off of 0.36, the ActiTest negative predictive value
for excluding significant necrosis (prevalence 0.41) was 85%.
· In
three studies there was a direct comparison in the same patients
of FT versus other biochemical markers, including hyaluronic
acid, the Forns index, and the APRI index.
· All
the comparisons favored FT (P < 0.05).
· There
were no differences between the AUROCs of FT-AT according
to genotype or viral load.
· The
AUROCs of FT-AT for consecutive stages of fibrosis and grades
of necrosis were the same for both moderate and extreme stages
and grades.
· A
conversion table was constructed between the continuous FT-AT
values (0.00 to 1.00) and the expected semi-quantitative fibrosis
stages (F0 to F4) and necrosis grades (A0 to A3).
Conclusions
In
closing, the authors write, “Based on these results, the use
of the biochemical markers of liver fibrosis (FibroTest) and
necrosis (ActiTest) can be recommended as an alternative to
liver biopsy for the assessment of liver injury in patients
with chronic hepatitis C.”
“In
clinical practice, liver biopsy should be recommended only
as a second line test, i.e., in case of high risk of
error of biochemical tests.”
Groupe Hospitalier Pitie-Salpetriere,
47-83 Boulevard de l'Hopital, Paris, France.
07/20/05
Reference
T Poynard
and others. Overview of the diagnostic value of biochemical
markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis
(ActiTest) in patients with chronic hepatitis C. Comparative Hepatology 3(1):8. September 23, 2004.
 Additional
Liver Biopsy Articles
|
