Viral Hepatitis
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 28, 2007; 13(4): 525-531
Published online Jan 28, 2007. doi: 10.3748/wjg.v13.i4.525
Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B
Giada Sebastiani, Alessandro Vario, Maria Guido, Alfredo Alberti
Giada Sebastiani, Alessandro Vario, Alfredo Alberti, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
Maria Guido, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Alfredo Alberti, Department of Clinical and Experimental Medicine, Via Giustiniani 2, University of Padova, Padova 35100, Italy. alfredo_alberti@tin.it
Telephone: +39-49-8212294 Fax: +39-49-8211826
Received: October 1, 2006
Revised: November 13, 2006
Accepted: December 11, 2006
Published online: January 28, 2007
Abstract

AIM: To assess the performance of several non-invasive markers and of our recently proposed stepwise combination algorithms to diagnose significant fibrosis (F ≥ 2 by METAVIR) and cirrhosis (F4 by METAVIR) in chronic hepatitis B (CHB).

METHODS: One hundred and ten consecutive patients (80 males, 30 females, mean age: 42.6 ± 11.3) with CHB undergoing diagnostic liver biopsy were included. AST-to-Platelet ratio (APRI), Forns’ index, AST-to-ALT Ratio, Goteborg University Cirrhosis Index (GUCI), Hui’s model and Fibrotest were measured on the day of liver biopsy. The performance of these methods and of sequential algorithms combining Fibrotest, APRI and biopsy was defined by positive (PPV) and negative (NPV) predictive values, accuracy and area under the curve (AUC).

RESULTS: PPV for significant fibrosis was excellent (100%) with Forns and high (> 92%) with APRI, GUCI, Fibrotest and Hui. However, significant fibrosis could not be excluded by any marker (NPV < 65%). Fibrotest had the best PPV and NPV for cirrhosis (87% and 90%, respectively). Fibrotest showed the best AUC for both significant fibrosis and cirrhosis (0.85 and 0.76, respectively). Stepwise combination algorithms of APRI, Fibrotest and biopsy showed excellent performance (0.96 AUC, 100% NPV) for significant fibrosis and 0.95 AUC, 98% NPV for cirrhosis, with 50%-80% reduced need for liver biopsy.

CONCLUSION: In CHB sequential combination of APRI, Fibrotest and liver biopsy greatly improves the diagnostic performance of the single non-invasive markers. Need for liver biopsy is reduced by 50%-80% but cannot be completely avoided. Non-invasive markers and biopsy should be considered as agonists and not antagonists towards the common goal of estimating liver fibrosis.

Keywords: Chronic hepatitis B; Hepatic fibrosis; Liver biopsy; Non-invasive markers; Stepwise combination algorithms