NON INVASIVE ASSESSMENT OF NON INVASIVE ASSESSMENT OF LIVER FIBROSIS : FIBROSCAN LIVER FIBROSIS : FIBROSCAN M. Beaugrand M. Beaugrand Service d Service d ’ ’ H H é é patologie patologie Hopital J. Verdier Hopital J. Verdier BONDY 93143 BONDY 93143 et Universit et Universit é é Paris XIII Paris XIII MAINZ 21.09.2008
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NON INVASIVE ASSESSMENT OF NON INVASIVE ASSESSMENT OF LIVER FIBROSIS : FIBROSCAN LIVER FIBROSIS : FIBROSCAN
M. BeaugrandM. BeaugrandService dService d’’HHéépatologiepatologie
Hopital J. VerdierHopital J. VerdierBONDY 93143BONDY 93143
et Universitet Universitéé Paris XIIIParis XIII
MAINZ 21.09.2008
ASSESSMENT OF FIBROSIS : WHY ?ASSESSMENT OF FIBROSIS : WHY ?
Management Management ofof individualindividual patientspatients•• SignificantSignificant fibrosisfibrosis TreatmentTreatment•• CirrhosisCirrhosis ScreeningScreening for varices for varices andand HCCHCC
ScreeningScreening for for cirrhosiscirrhosis or extensive or extensive fibrosisfibrosis•• In In highhigh riskrisk patientspatients•• In In thethe generalgeneral populationpopulation
Only fibrosisOnly fibrosis was significantly correlated to liver stiffness was significantly correlated to liver stiffness measurement.measurement.
0
0.2
0.4
0.6
0.8
1
0 0.2 0.4 0.6 0.8 1
1 - Specificity
Sens
itivi
ty
F01 versus F234
F012 versus F34
F0123 versus F4
VALIDATION OF DIAGNOSIS ACCURACY IN AN INDEPENDENT HCV POPULATION
Total number of included patients: 639Number of unreliable liver samples: 86 (13%)Number of unreliable LSM: 59 (9%)Patients kept for statistical analysis : 494
* Obtained by the jack* Obtained by the jack--knife method.knife method.
The optimum thresholds were chosen to maximize the The optimum thresholds were chosen to maximize the sum of sensitivity and specificity.sum of sensitivity and specificity.
FIBROSCAN IN HBV PATIENTS202 patients
- 15 non interpretable biopsies
- 14 LSM considered as non reliable
Statistical analysis on 173 patients
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 0.2 0.4 0.6 0.8 1
1 - Specificity
Sens
itivi
ty
F01 versus F234
F0123 versus F34
F0123 versus F4
AUROC
F01 versus F234: 0.81 (0.73-0.86)
F012 versus F34: 0.93 (0.88-0.96)
F0.123 versus F4: 0.93 (0.82-0.98)
FIBROSCAN VERSUS BLOOD TESTSFIBROSCAN VERSUS BLOOD TESTS
1
10
100
F1 F2 F3 F4
Fibrosis stage
1
10
100
F1 F2 F3 F4
Fibrosis stage
0.0
0.3
0.7
1.0
F1 F2 F3 F4
Fibrosis stage
0.0
2.0
4.0
6.0
F1 F2 F3 F4
Fibrosis stage
Elas
ticité
(kPa
)
FibroScan FibroTest APRI
Score METAVIR de fibrose Score METAVIR de fibrose Score METAVIR de fibrose
Castera Al. Gastroenterology 2005
CONCORDANCE WITH LIVER BIOPSYCONCORDANCE WITH LIVER BIOPSY
Steatohepatitis rho=0.22; p=0.16 All patients rho=0.60; p<0.0001
Live
rstif
fnes
s(k
Pa)
Fibrosis fraction area (%)
Figure 2
SCREENING IN HIGH RISK PATIENTSSCREENING IN HIGH RISK PATIENTS
41
34
33
LSM
Blood tests
Confirmation of cirrhosis
LB
LSM>13 kPayes
Absence ofcirrhosis
Suspectedcirrhosis
no
227 patients in alcoholicabstinence program
CONCLUSIONCONCLUSION
1)1) In patients In patients withwith chronicchronic live live diseasedisease LSM LSM reflectsreflects thethe arrountarrount ofof liverliver fibrosisfibrosis..
2)2) ItIt hashas particularlyparticularly goodgood performances for performances for thethediagnosisdiagnosis ofof cirrhosiscirrhosis
3)3) Fibroscan Fibroscan mightmight bebe a a reliablereliable screeningscreening tooltoolfor for thethe diagnosisdiagnosis ofof cirrhosiscirrhosis in in highhigh riskriskgroups or groups or eveneven in in thethe generalgeneral population.population.
FUTUREFUTURE
ImprovementsImprovements to to comecome•• ImprovementImprovement in softwarein software•• New probes for New probes for obeseobese patients patients andand alsoalso for for