Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C
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 aspa...
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doaj-47e64e70773a4a9a855df245e3bd3a2c2020-11-24T23:01:04ZengAssociação Brasileira de Divulgação CientíficaBrazilian Journal of Medical and Biological Research1414-431X2016-01-0149910.1590/1414-431X20165432S0100-879X2016000900702Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis CL.C. MendesP.A. FerreiraN. MiottoL. ZanagaE. GonçalesM.S. LazariniF.L. Gonçales JúniorR.S.B. StucchiA.G. ViganiAlthough 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/m2 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2016000900702&lng=en&tlng=enLiver biopsyNoninvasive testsAPRITransient elastographyAccuracyFalse results |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
L.C. Mendes P.A. Ferreira N. Miotto L. Zanaga E. Gonçales M.S. Lazarini F.L. Gonçales Júnior R.S.B. Stucchi A.G. Vigani |
spellingShingle |
L.C. Mendes P.A. Ferreira N. Miotto L. Zanaga E. Gonçales M.S. Lazarini F.L. Gonçales Júnior R.S.B. Stucchi A.G. Vigani Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C Brazilian Journal of Medical and Biological Research Liver biopsy Noninvasive tests APRI Transient elastography Accuracy False results |
author_facet |
L.C. Mendes P.A. Ferreira N. Miotto L. Zanaga E. Gonçales M.S. Lazarini F.L. Gonçales Júnior R.S.B. Stucchi A.G. Vigani |
author_sort |
L.C. Mendes |
title |
Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C |
title_short |
Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C |
title_full |
Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C |
title_fullStr |
Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C |
title_full_unstemmed |
Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C |
title_sort |
transient elastography and apri score: looking at false positives and false negatives. diagnostic performance and association to fibrosis staging in chronic hepatitis c |
publisher |
Associação Brasileira de Divulgação Científica |
series |
Brazilian Journal of Medical and Biological Research |
issn |
1414-431X |
publishDate |
2016-01-01 |
description |
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/m2 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. |
topic |
Liver biopsy Noninvasive tests APRI Transient elastography Accuracy False results |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2016000900702&lng=en&tlng=en |
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