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Another Biopsy Alternative For Hepatitis C Patients

November 27, 2004

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It seems doctors all want to do biopsies for liver patients, especially with Hepatitis C. In order to undergo interferon therapy doctors insist on a biopsy first.

Until recently there was no other way to get an exact measurement of fibrosis progression. We have already reported on a few blood tests that are currently approved for measuring fibrosis instead of undergoing a biopsy. One is Fibrospect and another is FibroTest.

Now, there is a report of yet another way to assess fibrosis without sticking a needle through your abdomen and into your liver.

This is great news for hemophiliacs and those of us who prefer to avoid the possible negative side effects of a biopsy (bleeding into the abdomen, liver damage, etc.).

Non-invasive Assessment of Liver Fibrosis by Liver Stiffness Measurement (LSM) in HCV Patients

Despite limitations such as sampling error and risks of complications, liver biopsy remains the gold standard for assessment of liver fibrosis. Among alternative non invasive methods, LSM based on transient elastography appears promising.

The purpose of this study was to investigate in comparison with histological staging in patients with chronic hepatitis C (CHC) focusing on patients with the largest liver biopsy samples.

French researchers prospectively included 327 patients with CHC who underwent both liver biopsy and LSM in four centers. LSM was performed with the FibroScan (Echosens Co, Paris, France) a non invasive device measuring liver stiffness in a volume of parenchyma of about 1,5 cm3.

In order to minimize the bias of histological evaluation, fibrosis stage was assessed according to METAVIR classification by two experienced pathologists. Moreover, biopsies were selected to have at least ten portal tracts or obvious cirrhosis.

The studied population was then split into two groups according to the biopsy sample length: biopsy sample larger than the median size (18 mm for F01, F2 and F3 patients and 13 mm for F4 patients) were considered separately.

Taking into account the whole studied population, LSM was significantly correlated with fibrosis stage (Kendall tau beta coefficient of correlation: 0.55, p < 0.0001) and the area under the ROC curves was 0.79 for F ≥ 2, 0.91 for F ≥ 3 and 0.97 for F = 4. These values were even improved when only the largest biopsies were considered: 0.81 for F ≥ 2, 0.95 for F ≥ 3 and 0.99 for F = 4.

The authors conclude, “LSM is a reliable, non invasive method for the evaluation of liver fibrosis in patients with CHC. The volume of liver parenchyma explored obviates the risk of sampling error present in liver biopsy.”

11/24/04
Reference
M Ziol and others. NON INVASIVE ASSESSMENT OF LIVER FIBROSIS BY LIVER STIFFNESS MEASUREMENT (LSM) IN PATIENTS WITH CHRONIC HEPATITIS C (CHC): THE IMPORTANCE OF SAMPLING. Abstract 263 (poster). 55th AASLD. October 29-November 2, 2004. Boston, MA.

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