The diagnostic accuracy of fibroscan for cirrhosis is influenced by liver morphometry in HCV patients with an SVR

Background & Aim. Transient elastography (TE) is a validated non-invasive method to evaluate hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection. However it has never been evaluated in patients with HCV-related cirrhosis and a sustained virological response (SVR). The aim of this study was to assess the accuracy of TE for the detection of liver fibrosis in HCV cirrhotic patients achieving a SVR. Materials and Methods. A liver biopsy (mean length: 24 mm) was performed in 38 patients with pre-treatment cirrhosis 61 months (range 46–104) after the achievement of a SVR. Liver fibrosis and necroinflammatory activity were assessed by METAVIR scoring system. The area of fibrosis was assessed by morphometry (%). Liver stiffness was measured by TE in parallel with the liver biopsy using a cut-off >12 kPa for the prediction of cirrhosis (F4). ROC curve analysis was used to assess TE diagnostic accuracy in predicting F4. Results. Cirrhosis was still present in 15 (39%) patients, whereas 23 (61%) showed a histological down-staging to F1 (5%), F2 (18%) and F3 (38%). TE was unreliable due to a success rate < 60% and/or inter-quartile range > 30% in 10 (26%, 4 with F4 and 6 with F<4) patients. Median TE value did not differ significantly between F4 and F<4 patients (12.4 kPa vs 9.2 kPa, p=0.3, respectively). 5/11 (45%) cirrhotics had a TE of less than 12 kPa and 1/17 (6%) non-cirrhotic patient had a TE higher than 12 kPa. The diagnostic accuracy of TE for F4 was: 54% sensitivity, 94% specificity, 9 LR +, 0.48 LR −, AUROC 0.77. Overall, the fibrosis amount assessed by morphometry decreased in 34 (89%) patients, with the baseline median collagen decreasing from 9.0% (2.9%-23.8%) to 2.4% (0.6%-15.1%; p<0.0001) after treatment, the reduction being significant also in patients still remaining F4 (p=0.006). A significant positive correlation was observed between the area of fibrosis and TE values (r 0.54; p = 0.01). Conclusions. In SVR patients with HCV, TE has low accuracy for the detection of cirrhosis as a consequence of liver fibrosis remodelling