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| |  Transient Elastography Accurate for Excluding Advanced Fibrosis in NAFLD HOBOKEN, NJ -- January 27, 2010 -- Transient elastography (TE) can be accurately performed in the majority of patients with nonalcoholic fatty liver disease (NAFLD) to exclude advanced fibrosis, according to a study published in the February issue of the journal Hepatology. Determining a prognosis for NAFLD is difficult, as there are no clear predictors of whether NAFLD will progress to nonalcoholic steatohepatitis (NASH). Liver biopsy is the standard for diagnosing NASH and fibrosis, but this procedure can be risky and samples only a small percentage of liver tissue. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), Bethesda, Maryland, biopsy carries a small risk of haemorrhage, puncture of other internal organs, infection, and spread of cancer cells. Transvenous liver biopsy carries an additional risk of adverse reaction to the contrast material. To meet the urgent need for noninvasive alternatives to liver biopsy, Victor de Lédinghen, MD, Service d’Hépato-Gastroentérologie, Hôpital Haut Lévêque, Avenue Magellan 33604, Pessac Cedex, France, and colleagues conducted an evaluation of the accuracy of TE and biochemical tests for the diagnosis of fibrosis and cirrhosis in NAFLD patients. “Transient elastography by Fibroscan is a non-invasive method for the diagnosis of liver fibrosis…Nevertheless, NAFLD patients are underrepresented in previous validation studies,” explained Dr. de Lédinghen. The team also examined liver stiffness in association with hepatic steatosis, inflammation, and obesity, and set out to identify factors associated with discordance between liver stiffness measurements (LSM) and histology. The researchers evaluated 246 patients from 2 ethnic groups from 2 hospitals in France and Hong Kong with valid LSM acquisitions and satisfactory liver biopsy specimens. Men who consumed more than 30 g of alcohol per week and women who consumed more than 20 g of alcohol per week were excluded. Patients with secondary causes of hepatic steatosis (e.g. chronic use of systemic corticosteroids), positive hepatitis B surface antigen or anti-hepatitis C virus antibody, or histologic evidence of other concomitant chronic liver diseases were also excluded. Since the aim of transient elastography was to diagnose significant fibrosis and early cirrhosis, patients with clinical and radiological evidence of cirrhosis were excluded. Researchers found that successful measurement could be obtained in over 97% of patients with a body mass index (BMI) <30 kg/m2 and 75% of obese patients. LSM was not affected by hepatic steatosis, necroinflammation, and obesity. Most discordance between TE and histology occurred in patients with short liver biopsy lengths and mild or no fibrosis. In addition, TE had superior performance to other non-invasive biochemical tests in diagnosing advanced fibrosis and cirrhosis. “The adoption of transient elastography could potentially spare two-thirds of NAFLD patients from liver biopsies,” said Dr. de Lédinghen. “Since the prevalence of NAFLD is high in many affluent countries, this approach would be cost saving.” Dr. de Lédinghen also cautions that while TE has a high negative predictive value, the positive predictive value of TE and other noninvasive tests to diagnose advanced fibrosis in NAFLD patients remains modest. “The main value of these tests is to exclude advanced fibrosis as screening tests,” he said. “Based on our data, it is reasonable to consider liver biopsy in patients whose LSM is 7.9 kPa or above.”
SOURCE: Wiley-Blackwell
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