Larger Biopsies Evaluation of Transient Elastography for Detecting Advanced Fibrosis in Patients with Compensated Chronic Hepatitis B

Chen YP et al. – Inadequate sample study would underestimate the efficiency of transient elastography (TE) on detecting advanced fibrosis. With ALT 2×ULN stratified cutoffs, TE determined nearly 80% of patients with normal bilirubin as AF or non–AF and obviated them from liver biopsies.

Methods

• A total of 375 compensated patients were analyzed, which had undergone liver biopsy, reliable TE and routine blood tests.

Results

• The area under receiver operating characteristic curve (AUC) was influenced by liver biopsy sample: 0.873 (95% confidence interval 0.838–0.909) in total patients, 0.880 (0.844–0.917) in length ≥15mm, 0.897 (0.863–0.932) in length ≥20mm and 0.911 (0.874–0.949) in length ≥25mm.
• In patients with sample length ≥20mm, the cutoffs to exclude and confirm advanced fibrosis were 7.1kPa and 12.7kPa, respectively.
• Stratified by ALT 2×ULN, transient elastography detecting advanced fibrosis with the most efficiency by 72.5% of patients obviated from liver biopsy.
• In patients with normal bilirubin and ALT <2×ULN, the area was 0.921 (0.860–0.982), and cutoffs for excluding and confirming diagnosis were 7.4kPa and 10.6kPa, respectively; 80% of patients could be classified with or without AF.
• In patients with normal bilirubin and ALT ≥2×ULN, the corresponding numbers were 0.885 (0.824–0.947), 7.5kPa, 12.7kPa and 79.2%, respectively.

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