Dietje Fransen van de Putte, Renske Blom, Hanneke van Soest, Marco Mundt, Claudia Verveer, Joop Arends, Robert E. de Knegt, Eveline Mauser-Bunschoten, Karel van Erpecum
Background. Liver stiffness measurement (LSM) using Fibroscan® is an increasingly popular non-invasive method for quantifying liver fibrosis in patients with chronic viral hepatitis. We aimed to explore potential impact of Fibroscan® on clinical management. Material and methods. 133 patients with chronic hepatitis B (HBV, n = 75) or C (HCV, n = 58) underwent Fibroscan® measurement. LSM results were compared with liver biopsy results, ultrasound, and APRI-scores, and the impact of LSM on clinical management was evaluated. Results. LSM results indicated fibrosis stage F0-F1 in 84 patients (63%), F2 in 28 (21%), F3 in 8 (6%), and F4 in 13 patients (10%). Nineteen patients had liver biopsies within one year of LSM. In ten patients, LSM and biopsy showed the same fibrosis stage, in 8 there was one stage difference, and in 1 three stages difference. Ultrasound only showed cirrhosis in three patients, who all exhibited advanced cirrhosis at LSM. There was a statistically significant, but weak correlation between LSM results and APRI scores (r = 0.31, pvalue < 0.001). LSM results changed clinical management in 39% of patients (55 cases): in 15 patients antiviral treatment was indicated, in 21 patients surveillance for hepatocellular carcinoma was indicated, and 19 successfully treated hepatitis C patients could be discharged from clinical follow-up in absence of severe fibrosis or cirrhosis. Conclusion. LSM appears to be a valuable non-invasive tool to manage patients with chronic viral hepatitis in clinical practice.
Key words. Biopsy, Fibrosis, Hepatitis B, Hepatitis C, Liver cirrhosis, Ultrasonography