Correlation Between Liver Biopsy And Fibrotest In The Evaluation Of Hepatic Fibrosis In Patients With Chronic Hepatitis C

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Published Aug 4, 2010
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Vol. 88 No. 8 (2010): Issue Aug 2010

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Yosra Said
Slim Bouzaidi
Radhouane Debbeche
Senda Trabelsi
Amel Moussa
Majd Ben Rejeb
Fatma Houissa
Heifa Mekki
Leila Mouelhi
Mohamed Salem
Taoufik Najjar

Abstract

Aim: To assess the diagnostic value of Fibrotest in comparison with liver biopsy, for the evaluation of hepatic fibrosis in patients with chronic hepatitis C.
Methods: This prospective study included in 2 years (2006-2007), consecutive patients with chronic hepatitis C naive to treatment. Fibrotest and liver biopsy were performed. Receiver operating characteristics (ROC) curves , the sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic value of Fibrotest in comparison with the METAVIR classification.
Results:We recruited a total of 65 patients: 28 males and 37 females (mean age: 50 years); 92% of the patients had genotype 1. The histological fibrosis results were: 3. 1% F0; 24. 6% F1; 32. 3%F2; 29. 2%F3 and 10. 8 %F4. The diagnostic value of Fibrotest in the detection of significant fibrosis (F2-F4) was 0. 87. A score >0. 5 has a sensitivity of 85. 1%, a specificity of 72. 2%, a positive predictive value of 88. 9%,and a negative predictive value of 65%. The diagnostic value of Fibrotest in the detection of cirrhosis (F4) was0. 85. There were 13/65 cases of discordance (20%) for fibrosis, 4 cases were attributable to biopsy and 6 cases to Fibrotest. The discordance was unexplained in 3 cases. the size of biopsy<15mm [OR=2. 82, 95% CI, 1. 3–6. 07; p =0. 008] and the stage of fibrosis F0,F1,F2 [OR  =3. 35 , 95% CI, 1. 1–10. 2; p=0. 03] were considered as risk factors of discordance in multivariate analysis.
Conclusion: This prospective study confirmed the good diagnostic value of Fibrotest as compared with the histological analysis of liver biopsy.

Keywords:

hepatitis C, fibrosis, liver, biopsy, Biological Markers

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References

  1. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344:495-500.
  2. Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am JGastroenterol2002;97: 2614-8.
  3. Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: The smaller the sample, the milder the disease. J Hepatol 2003; 39:239-44.
  4. Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology2003;38:1449-57.
  5. Bedossa P, Poynard T, Naveau S, Martin ED, Agostini H, Chaput JC.Observer variation in assessment of liver biopsies of alcoholic patients.Alcohol Clin Exp Res 1988;12:173-8
  6. Labayle D, Chaput JC, Albuisson F, Buffet C, Martin E, Etienne JP.Comparison of the histological lesions in tissue specimens taken from the right and left lobe of the liver in alcoholic liver disease.Gastroenterol Clin Biol 1979;3:235-40.
  7. McHutchison J, Poynard T, Afdhal N; International Fibrosis Group Meeting Participants. Fibrosis as an end point for clinical trials in liver disease: A report of the international fibrosis group. Clin GastroenterolHepatol2006;4: 1214-20.
  8. Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol 2000; 14:543-8.
  9. Adams LA, Bulsara M, Rossi E, DeBoer B, Speers D, George J, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005; 51:1867-73.
  10. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology2005;128:343-50.
  11. Calès P, Oberti F, Michalak S, Hubert-Fouchard I, Rousselet MC, Konate A, et al. A novel panel of blood markers to assess the degree of liver fibrosis. Hepatology2005; 42:1373-81.
  12. Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, BenhamouY, Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet2001; 357:1069-75.
  13. Leroy V, Monier F, Bottari S, Trocme C, Sturm N, Hilleret MN,et al. Circulating matrix metalloproteinases 1, 2, 9 and their inhibitors TIMP-1 and TIMP-2 as serum markers of liver fibrosis in patients with chronic hepatitis C: comparison with PIIINP and hyaluronic acid. Am J Gastroenterol 2004; 99:271-9.
  14. Patel K, Gordon SC, Jacobson I, Hezode C, Oh E, Smith KM,et al. Evaluation of a panel of non-invasive serum markers to differentiate mild from moderate-to-advanced liver fibrosis inchronichepatitisCpatients.JHepatol2004;41:935-42.
  15. Rosenberg WM, Voelker M, Thiel R, Becka M, Burt A,Schuppan D, et al. Serum markers detect the presence of liver fibrosis: a cohort study.Gastroenterology2004;127:1704-13.
  16. Karoui S, Jomni T, Bellil K, Haouet S, Boubaker J, Filali A. Predictive factors of fibrosis for chronic viral hepatitis C.Tunis Med. 2007 ;85:454-60.
  17. Bourliere M, Penaranda G, Renou C, Botta-Fridlund D, TranA, Portal I, et al. Validation and comparison of indexes forfibrosis and cirrhosis prediction in chronic hepatitis C patients:proposal for a pragmatic approach classification without liver biopsies. J Viral Hepat 2006; 13:659-70.
  18. Imbert-Bismut F, Messous D, Thibault V, Myers RB, Piton A,Thabut D, et al. Intra-laboratory analytical variability of biochemical markers of fibrosis (Fibrotest) and activity (Actitest)and reference ranges in healthy blood donors. Clin Chem LabMed 2004;42:323-33.
  19. Poynard T, Imbert-Bismut F, Ratziu V, Chevret S, Jardel C, Moussalli J, et al. Biochemical markers of liver fibrosis in patientsinfected by hepatitis C virus: longitudinal validation in a randomized trial. J Viral Hepat2002;9:12833.
  20. Poynard T, Munteanu M, Ngo Y, Torres M, Benhamou Y, Thabut D,et al. Diagnostic value of FibroTest with normal serum aminotransferases. Hepatology2006;43:374-5.
  21. Poynard T, Halfon P, Castera L, Charlotte F, Le Bail B, Munteanu M, et al. Variability of the area under the receiver operatingcharacteristic curves in the diagnostic evaluation of liverfibrosis markers: impact of biopsy length and fragmentation.Aliment Pharmacol Ther 2007; 25:733-9.
  22. Halfon P, Bourliere M, Deydier R, Botta-Fridlund D, Renou C, Tran A, et al. Independent prospective multicenter validation of biochemical markers (fibrotest-actitest) for the prediction of liver fibrosis and activity in patients with chronic hepatitisC: the fibropaca study. Am J Gastroenterol 2006; 101:547- 55.
  23. Poynard T, Munteanu M, Imbert-Bismut F, Charlotte F, Thabut D, Le Calvez S, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitisC.ClinChem2004;50:1344-55.
  24. Sebastiani G, Alberti A. Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy. World J Gastroenterol 2006; 21: 3682- 94.
  25. Poynard T, Ratziu V, Benhamou Y, Thabut D, Moussalli J. Biomarkers as a first-line estimate of injury in chronic liver diseases: Time for a moratorium on liver biopsy? Gastroenterology 2005; 128:1146-8.
  26. Castera L, Denis J, Babany G, Roudot-Thoraval F. Evolving practices of non-invasive markers of liver fibrosis in patients with chronic hepatitis C in France: Time for new guidelines? J Hepatol 2007; 46:528-9.
  27. La Haute Autorité de Santé (HAS) in France - The HAS recommendations for the management of the chronic hepatitis C using nohttp://www.has-sante.fr /portail/display.jsp?id= c_47 6486.n -invasive biomarkers.
  28. Poynard T, Imbert-Bismut F, Munteanu M, Messous D, Myers RP, Thabut D, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV-Fibrosure) and necrosis (ActiTest) in patients with chronic hepatitis C. Comp Hepatol 2004;3:8.
  29. Poynard T, Morra R, Halfon P, Castera L, Ratziu V, Imbert- Bismut F, et al. Meta-analyses of Fibrotest diagnostic value in chronic liver disease. BMC Gastroenterol 2007;7:40.
  30. Poynard T, Morra R, Ingiliz P, Imbert Bismut F, Thabut D, Messous D, et al. Biomarkers of liver fibrosis.Adv Clin Chem 2008;46:131-52.
  31. Poynard T, Muntenau M, Morra R, Ngo Y, Imbert-Bismut F, Thabut D et al. Methodological aspects for the interpretation of liver fibrosis non-invasive biomarkers: A 2008 update. Gastroenterol ClinBiol2008;32:8-21.
  32. Halfon P, Munteanu M, Poynard T. Fibrotest-Actitest as a non invasive marker of liver Fibrosis seven years ago: A 2008 updated meta-analyses of FT diagnostic and prognosis values in chronic liver diseases. Gastroenterol Clin Biol. 2008 Sep;32(6 Suppl 1):22-39.
  33. Poynard T, Morra R, Ingiliz P, Imbert-Bismut F, Thabut D, Messous D, et al.Saudi J Gastroenterol. 2008 Oct;14:163-73.
  34. Poynard T, McHutchison J, Manns M, Myers RP, Albrecht J. Biochemical surrogate markers of liver fibrosis and activity in a randomized trial of peginterferon alfa-2b and ribavirin. Hepatology 2003;38:481-92.
  35. Ratziu V, Massard J, Charlotte F, Messous D, Imbert-Bismut F, Bonyhay L, et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol 2006; 6:6.
  36. Naveau S, Raynard B, Ratziu V, Abella A, Imbert-Bismut F, MessousD, et al. Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease. Clin Gastroenterol Hepatol 2005;3:167-74.
  37. Ngo Y, Munteanu M, Messous D, Charlotte F, Imbert-Bismut F, Thabut D, et al. A prospective analysis of the prognostic value of biomarkers (FibroTest) in patients with chronic hepatitis C. Clin Chem 2006; 52:1887-96.