Liver
biopsy is considered the "gold standard" for assessing liver
disease progression, but given that the procedure is uncomfortable and expensive,
researchers have sought to develop non-invasive methods for measuring liver
fibrosis. One such measure is liver stiffness, assessed using a technique
known as transient elastography (FibroScan).
As
reported in the December 2006 American Journal of Gastroenterology, French
researchers estimated the additional value of liver
stiffness measurement (LSM) when used in conjunction with epidemiological,
clinical, and biological parameters.
The
study included 142 unselected patients with chronic hepatitis C. Liver biopsy
and LSM were performed simultaneously. First, 4 physicians -- 2 junior residents
with limited experience in hepatology and 2 senior hepatologists -- independently
predicted the patients' liver fibrosis stage (METAVIR classification) using clinical,
epidemiological, and biological data. Then, the physicians were informed of patients'
LSM values and allowed to modify their initial evaluation. Finally, the 2 successive
evaluations were compared with the histological fibrosis score as determined by
biopsy.
Results
•
Providing LSM values improved
agreement among physicians and resulted in a better correlation between clinical
impression and histological fibrosis scores.
•
Diagnostic performance was
only significantly improved with transient elastography for the diagnosis of cirrhosis,
where assessment improved in 3 of the 4 physicians.
•
Performance was similar for
junior and senior physicians when LSM was provided.
•
Areas under the receiver operating
curve (AUROC) ranged from 0.69 to 0.72 for significant fibrosis, and from 0.87
to 0.90 for cirrhosis.
Conclusion
"Providing
LSM values to physicians results in a better estimation of liver fibrosis and
a more accurate diagnosis of cirrhosis," the authors concluded. "Moreover,
it allows physicians with limited experience to predict liver fibrosis as well
as experienced hepatologists."
The
results of this study support the usefulness of transient elastography under certain
circumstances, but are in accord with past research showing that the technique
works best for diagnosing advanced fibrosis or cirrhosis, but performs less well
at detecting mild-to-moderate liver disease.
02/02/07
Reference P
Nahon, G Thabut, M Ziol, and others. Liver stiffness measurement versus clinicians'
prediction or both for the assessment of liver fibrosis in patients with chronic
hepatitis C. American Journal of Gastroenterology 101(12): 2744-2751. December
2006.
