Transient elastography and apri score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis c

Transient elastography and apri score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis c

Author Mendes, L. C. Google Scholar
Ferreira, P. A. Autor UNIFESP Google Scholar
Miotto, N. Google Scholar
Zanaga, L. Google Scholar
Goncales, E. Google Scholar
Lazarini, M. S. Google Scholar
Goncales Junior, F. L. Google Scholar
Stucchi, R. S. B. Google Scholar
Vigani, A. G. Google Scholar
Abstract Although long regarded as the gold standard for liver fibrosis staging in chronic hepatitis C (CHC), liver biopsy (LB) implies both the risk of an invasive procedure and significant variability. The aim of this study was to evaluate the diagnostic performance for transient elastography (TE) and aspartate aminotransferase to platelet index (APRI) used alone and in combination compared to liver biopsy and to analyze false positive/negative results. Patients with CHC, and no previous clinical diagnosis of cirrhosis were enrolled to undergo liver biopsy, TE and APRI. A total of 182 adult patients with a median age of 55 years and median body mass index of 26.71 kg/m(2) were analyzed. On LB, 56% of patients had significant levels of fibrosis (METAVIR F >= 2) and 28% had advanced fibrosis (F3/F4). The strongest performance for both tests was observed for exclusion of advanced fibrosis with good negative predictive values (89 and 86%, respectively). Low necroinflammatory activity on LB was associated with false negative TE. False positives were associated with NASH and smaller LB fragments. Correlation between APRI and Fibroscan for F >= 2 was 100% and 84% for F >= 3 and remained high in both false negative and false positive instances, correctly identifying F < 2 in 71% of cases and F < 3 in 78% (and potentially foregoing up to 84% of LB). We concluded that low individual performance indicators could be attributable to limitations of LB. Poorer differentiation of lower levels of fibrosis is a known issue for LB and remains so for noninvasive tests. Good predictability is possible, however, for advanced fibrosis.
Keywords Liver Biopsy
Noninvasive Tests
Apri
Transient Elastography
Accuracy
False ResultsChronic Viral-Hepatitis
Liver Fibrosis
Noninvasive Assessment
Stiffness Measurement
Biopsy
Cirrhosis
Accuracy
Infection
Multicenter
Prediction
Language English
Date 2016
Published in Brazilian Journal Of Medical And Biological Research. Sao paulo, v. 49, n. 9, p. e5432, 2016.
ISSN 0100-879X (Sherpa/Romeo, impact factor)
Publisher Hindawi Ltd
Extent e5432
Origin http://dx.doi.org/10.1590/1414-431X20165432
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000381098700009
SciELO ID S0100-879X2016000900702 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/49453

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