Evaluation of transient elastography for fibrosis assessment compared with large biopsies in chronic hepatitis B and C

Background: Fibrosis determines prognosis and management in patients with chronic hepatitis B and C (CHB and CHC). Transient elastography (TE) is a promising non-invasive method to assess fibrosis. We prospectively studied the performance of TE compared to histology and also whether there are differences between CHB and CHC. Only large biopsies (>= 25 mm) were used. Methods: We included 241 patients with CHB (n = 125) and CHC (n = 116), of whom we acquired 257 liver biopsies, all preceded by elastography. We correlated liver stiffness with fibrosis stage according to the METAVIR system, inflammation (Histology Activity Index), steatosis and iron. The impact of gender, age, body mass index, alcohol, alanine aminotransferase levels, platelet count, viral load and genotype on liver stiffness was evaluated. Results: The AUROC's for F >= 2 were 0.85 for CHB and 0.76 for CHC. AUROC's for F >= 3 were 0.91 for CHB and 0.87 for CHC and 0.90 and 0.91 for F4 for CHB and CHC respectively. For F >= 2 the cut-off value was 6.0 kPa for CHB and 5.0 kPa for CHC. The cut-off values for >= F3 were 9.0 and 8.0 kPa for CHB and CHC, respectively, and 13.0 kPa for F4 in both CHB and CHC patients. Besides inflammation, all other remaining factors do not influence liver stiffness. Conclusion: For the diagnosis of fibrosis stages F <= 2 TE is suboptimal, and inflammation may induce higher values. For stages F >= 3 TE performance is good and equal in both CHB and CHC patients.