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Petta S, Wong VWS, Cammà C, Hiriart JB, Wong GLH, Vergniol J, Chan AWH, Di Marco V, Merrouche W, Chan HLY, Marra F, Le-Bail B, Arena U, Craxì A, de Ledinghen V. Serial combination of non-invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD. Aliment Pharmacol Ther 2017; 46:617-627. [PMID: 28752524 DOI: 10.1111/apt.14219] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/03/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. AIM To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. METHODS We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. RESULTS LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (<-1.455 and <1.30, respectively) overall increased the diagnostic performance generating an accuracy ranging from 69.8% to 70.1%, an uncertainty area ranging from 18.9% to 20.4% and a rate of wrong classification ranging from 9.2% to 11.3%. CONCLUSION The serial combination of LSM with FIB-4/NFS has a good diagnostic accuracy for the non-invasive diagnosis of severe fibrosis in NAFLD.
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Affiliation(s)
- S Petta
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - V W-S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - C Cammà
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - J-B Hiriart
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - G L-H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - J Vergniol
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - A W-H Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - V Di Marco
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - W Merrouche
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - H L-Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - F Marra
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - B Le-Bail
- INSERM U1053, Bordeaux University, Bordeaux, France.,Service de Pathologie, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - U Arena
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - A Craxì
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - V de Ledinghen
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Bordeaux University, Bordeaux, France
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Petta S, Wong VWS, Cammà C, Hiriart JB, Wong GLH, Marra F, Vergniol J, Chan AWH, Di Marco V, Merrouche W, Chan HLY, Barbara M, Le-Bail B, Arena U, Craxì A, de Ledinghen V. Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values. Hepatology 2017; 65:1145-1155. [PMID: 27639088 DOI: 10.1002/hep.28843] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023]
Abstract
UNLABELLED Liver stiffness measurement (LSM) frequently overestimates the severity of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). Controlled attenuation parameter (CAP) is a new parameter provided by the same machine used for LSM and associated with both steatosis and body mass index, the two factors mostly affecting LSM performance in NAFLD. We aimed to determine whether prediction of liver fibrosis by LSM in NAFLD patients is affected by CAP values. Patients (n = 324) were assessed by clinical and histological (Kleiner score) features. LSM and CAP were performed using the M probe. CAP values were grouped by tertiles (lower 132-298, middle 299-338, higher 339-400 dB/m). Among patients with F0-F2 fibrosis, mean LSM values, expressed in kilopascals, increased according to CAP tertiles (6.8 versus 8.6 versus 9.4, P = 0.001), and along this line the area under the curve of LSM for the diagnosis of F3-F4 fibrosis was progressively reduced from lower to middle and further to higher CAP tertiles (0.915, 0.848-0.982; 0.830, 0.753-0.908; 0.806, 0.723-0.890). As a consequence, in subjects with F0-F2 fibrosis, the rates of false-positive LSM results for F3-F4 fibrosis increased according to CAP tertiles (7.2% in lower versus 16.6% in middle versus 18.1% in higher). Consistent with this, a decisional flowchart for predicting fibrosis was suggested by combining both LSM and CAP values. CONCLUSIONS In patients with NAFLD, CAP values should always be taken into account in order to avoid overestimations of liver fibrosis assessed by transient elastography. (Hepatology 2017;65:1145-1155).
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Affiliation(s)
- Salvatore Petta
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Calogero Cammà
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Jean-Baptiste Hiriart
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Fabio Marra
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Julien Vergniol
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Anthony Wing-Hung Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Vito Di Marco
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Wassil Merrouche
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Marco Barbara
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Brigitte Le-Bail
- INSERM U1053, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France.,Service de Pathologie, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Umberto Arena
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Antonio Craxì
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Victor de Ledinghen
- Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France.,INSERM U1053, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
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Sebillotte CG, Ribeiro E, Duffau P, Doassans-Cazaban L, Duvignaud A, Le-Bail B, Mercie P, Longy-Boursier M. Présentation pseudo tumorale d’une sarcoïdose hépatique. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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