Comparison between transient elastography (Fibroscan) and liver biopsy for the diagnosis of hepatic fibrosis in chronic hepatitis C genotype 4

Background and aim of the work: The accurate diagnosis of hepatitis C virus (HCV)-related fibrosis is crucial for prognosis and treatment decisions. Because of the limitations of liver biopsy, noninvasive alternatives including transient elastography (Fibroscan) have been developed. This study was conducted to compare transient elastography (Fibroscan) with histological examination by liver biopsy for the diagnosis of hepatic fibrosis among chronic hepatitis C genotype 4 patients and to evaluate the effects of activity, steatosis and the presence of schistosomiasis on transient elastography measurements. Patients and methods: This cross-sectional study included 519 chronic HCV patients with genotype 4, selected from attendees of the Mansoura Specialized Hospital, in the period between January 2009 and December 2010. History taking, complete clinical examination and routine laboratory investigations were performed. All patients were subjected to liver biopsy and Fibroscan examination. Liver fibrosis was staged on a 0-4 scale according to the METAVIR system. The diagnostic performance of Fibroscan was assessed by the analysis of the receiver operator characteristics curve (ROC), the sensitivity, the specificity, the positive predictive value (PPV) and the negative predictive value (NPV). Results: The cut-off value of significant fibrosis (≥F2) was 8.55. The ROC of liver stiffness measurement (LSM) was 0.86 [95% confidence interval (CI), 0.780-0.849] with 65.95% sensitivity, 84.43% specificity, 70.1% PPV and 81.7% NPV. The cut-off value of advanced fibrosis (≥F3) was 10.2. The ROC curve of LSM was 0.919 (95% CI, 0.892-0.941) with 83.70% sensitivity, 89.23% specificity, 62.6% PPV and 96.22% NPV. The cut-off value of cirrhosis (=F4) was 16.3. The ROC of LSM was 0.966 (95% CI, 0.946-0.980) with 100% sensitivity, 90.62% specificity, 27.7% PPV and 100% NPV. There was no significant difference (P= 0.387) between the indirect hemagglutination test status for schistosomiasis and the Fibroscan score. Also, there was no correlation between Fibroscan measurements and the steatosis degree (P=0.37). Conclusion: This study suggests that transient elastography by Fibroscan can be a new noninvasive tool to diagnose and monitor liver fibrosis among patients with HCV infection.