Accuracy of transient elastography-FibroScan (R), acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author RAGAZZO, Taisa Grotta FMUSP-HC
PARANAGUA-VEZOZZO, Denise FMUSP-HC
LIMA, Fabiana Roberto
MAZO, Daniel Ferraz de Campos FMUSP-HC
PESSOA, Mario Guimaraes FMUSP-HC
OLIVEIRA, Claudia Pinto FMUSP-HC
ALVES, Venancio Avancini Ferreira FMUSP-HC
CARRILHO, Flair Jose FMUSP-HC
dc.date.issued 2017
dc.identifier.citation CLINICS, v.72, n.9, p.516-525, 2017
dc.identifier.issn 1807-5932
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/24277
dc.description.abstract OBJECTIVES: Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan (R), acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C. METHODS: We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, Department of Gastroenterology of University of Sao Paulo School of Medicine, Sao Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (>= F2), advanced fibrosis (>= F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan (R), 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed. RESULTS: A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (>= F2): FibroScan (R) : 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (>= F3): FibroScan (R) : 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan (R) : 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively. CONCLUSION: Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.
dc.language.iso eng
dc.publisher HOSPITAL CLINICAS, UNIV SAO PAULO
dc.relation.ispartof Clinics
dc.rights openAccess
dc.subject Hepatitis C Chronic; Liver Cirrhosis; Elastography; Biomarkers/Blood; Disease Progression; Data Accuracy
dc.subject.other platelet ratio index; aspartate-aminotransferase; elastography fibroscan; risk-factors; stiffness; cirrhosis; metaanalysis; cohort; discordance; score
dc.title Accuracy of transient elastography-FibroScan (R), acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C
dc.type article
dc.rights.holder Copyright HOSPITAL CLINICAS, UNIV SAO PAULO
dc.description.group LIM/07
dc.description.group LIM/14
dc.identifier.doi 10.6061/clinics/2017(09)01
dc.identifier.pmid 29069254
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author RAGAZZO, Taisa Grotta:FM:
hcfmusp.author PARANAGUA-VEZOZZO, Denise:HC:ICHC
hcfmusp.author MAZO, Daniel Ferraz de Campos:HC:ICHC
hcfmusp.author PESSOA, Mario Guimaraes:HC:ICHC
hcfmusp.author OLIVEIRA, Claudia Pinto:FM:MGT
hcfmusp.author ALVES, Venancio Avancini Ferreira:FM:MPT
hcfmusp.author CARRILHO, Flair Jose:FM:MGT
hcfmusp.author.external · LIMA, Fabiana Roberto:Univ Estadual Campinas, Div Gastroenterol, Fac Ciencias Med, Campinas, SP, Brazil
hcfmusp.origem.id WOS:000413649800001
hcfmusp.origem.id 2-s2.0-85032462706
hcfmusp.origem.id SCIELO:S1807-59322017000900516
hcfmusp.publisher.city SAO PAULO
hcfmusp.publisher.country BRAZIL
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dc.description.index MEDLINE
dc.identifier.eissn 1980-5322
hcfmusp.citation.scopus 9
hcfmusp.citation.wos 6
hcfmusp.affiliation.country Brasil


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