Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B
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Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination.
Abstract
Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination.
참고문헌 (35)
- World Health Organization, "Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection", World Health Organization, ~ (2015)
- Yu SJ, "A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016", Clin Mol Hepatol, 22, pp.7~17 (2016)[DOI]
- Lai CL, "Prevention of hepatitis B virus-related hepatocellular carcinoma with antiviral therapy", Hepatology, 57, pp.399~408 (2013)[DOI]
- Bolondi L, "Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis", Gut, 48, pp.251~259 (2001)[DOI]
- Varbobitis I, "The assessment of hepatocellular carcinoma risk in patients with chronic hepatitis B under antiviral therapy", Clin Mol Hepatol, 22, pp.319~326 (2016)[DOI]
- Rockey DC, "Liver biopsy", Hepatology, 49, pp.1017~1044 (2009)[DOI]
- The French METAVIR Cooperative Study Group, "Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C", Hepatology, 20(1), pp.15~20 (1994)[DOI]
- Park SH, "What we need to know when performing and interpreting US elastography", Clin Mol Hepatol, 22, pp.406~414 (2016)[DOI]
- Bravo AA, "Liver biopsy", N Engl J Med, 344, pp.495~500 (2001)[DOI]
- Castera L, "Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C", Gastroenterology, 128, pp.343~350 (2005)[DOI]
- Heo JY, "Use of Wisteria floribunda agglutinin- positive human Mac-2 binding protein in assessing risk of hepatocellular carcinoma due to hepatitis B virus", Medicine (Baltimore), 95, pp.e3328~ (2016)[DOI]
- Castera L, "Hepatitis B: are non-invasive markers of liver fibrosis reliable?", Liver Int, 34(Suppl 1), pp.91~96 (2014)[DOI]
- Wong GL, "Personalized management of cirrhosis by non-invasive tests of liver fibrosis", Clin Mol Hepatol, 21, pp.200~211 (2015)[DOI]
- Kim BK, "Risk assessment of clinical outcomes in Asian patients with chronic hepatitis B using enhanced liver fibrosis test", Hepatology, 60, pp.1911~1919 (2014)[DOI]
- Fagan KJ, "ELF score <TEX>${\geq}$<", TEX>9.8 indicates advanced hepatic fibrosis and is influenced by age, steatosis and histological activity, 2015, pp.35, 1673~1681
- Irvine KM, "The enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease", Liver Int, 36, pp.370~377 (2016)[DOI]
- Guechot J, "Independent validation of the enhanced liver fibrosis (ELF) score in the ANRS HC EP 23 Fibrostar cohort of patients with chronic hepatitis C", Clin Chem Lab Med, 50, pp.693~699 (2012)
- Kim BK, "Prospective validation of ELF test in comparison with Fibroscan and FibroTest to predict liver fibrosis in Asian subjects with chronic hepatitis B", PLoS One, 7, pp.e41964~ (2012)[DOI]
- Seo YS, "Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: a multicentre, retrospective study", Liver Int, 35, pp.2246~2255 (2015)[DOI]
- Kim DY, "Transient elastography-based risk estimation of hepatitis B virus-related occurrence of hepatocellular carcinoma: development and validation of a predictive model", Onco Targets Ther, 6, pp.1463~1469 (2013)
- Lee HW, "Prediction of development of liverrelated events by transient elastography in hepatitis B patients with complete virological response on antiviral therapy", Am J Gastroenterol, 109, pp.1241~1249 (2014)[DOI]
- Wong GL, "Liver stiffness-based optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B", J Hepatol, 60, pp.339~345 (2014)[DOI]
- Wong GL, "Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B", Aliment Pharmacol Ther, 39, pp.197~208 (2014)[DOI]
- Korean Liver Cancer Study Group, "2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma", Korean Journal of Radiology, 16(3), pp.465~522 (2015), 대한영상의학회[DOI]
- Korean Association for the Study of the Liver, "KASL clinical practice guidelines: management of chronic hepatitis B", Clin Mol Hepatol, 22, pp.18~75 (2016)[DOI]
- Batts KP, "Chronic hepatitis: an update on terminology and reporting", Am J Surg Pathol, 19, pp.1409~1417 (1995)[DOI]
- Kim JH, "Clinical application of transient elastography in patients with chronic viral hepatitis receiving antiviral treatment", Liver Int, 35, pp.1103~1115 (2015)[DOI]
- Kim MN, "Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis", Hepatology, 61, pp.1851~1859 (2015)[DOI]
- Park MS, "Prognostic value of the combined use of transient elastography and FibroTest in patients with chronic hepatitis B", Liver Int, 35, pp.455~462 (2015)[DOI]
- Boursier J, "The combination of a blood test and Fibroscan improves the non-invasive diagnosis of liver fibrosis", Liver Int, 29, pp.1507~1515 (2009)[DOI]
- Chan HL, "Alanine aminotransferasebased algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B", J Viral Hepat, 16, pp.36~44 (2009)[DOI]
- Trembling PM, "Performance of enhanced liver fibrosis test and comparison with transient elastography in the identification of liver fibrosis in patients with chronic hepatitis B infection", J Viral Hepat, 21, pp.430~438 (2014)[DOI]
- Fung J, "Mild-tomoderate elevation of alanine aminotransferase increases liver stiffness measurement by transient elastography in patients with chronic hepatitis B", Am J Gastroenterol, 106, pp.492~496 (2011)[DOI]
- Wong GL, "Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B", J Gastroenterol Hepatol, 24, pp.1002~1007 (2009)[DOI]
- Wong VW, "Probability-based interpretation of liver stiffness measurement in untreated chronic hepatitis B patients", Dig Dis Sci, 60, pp.1448~1456 (2015)[DOI]