Fibroscan versus liver biopsy in the evaluation of response among the Egyptian HCV infected patients to treatment

Abstract

Background/aim: Hepatitis C virus (HCV) infection usually progress to chronic infection with subsequent cirrhosis and cancer. Therapies aim to eradicate the virus and prevent further progression. Interferon is claimed to have anti-fibrotic effect. Histopathology is the gold standard in diagnosis and grading of hepatic fibrosis, but transient elastogram (Fibroscan) can be used as alternative noninvasive modality. This prospective study aimed to evaluate the accuracy of fibroscan in diagnosis of liver fibrosis, and assess the effect of antiviral therapy on fibrosis stages in HCV patients. Patients and methods: The study was conducted from September 2012 to December 2014 as a project funded by Science and Technology Development Fund, Egypt, Grant No. 3448. It included 498 patients; 150 HCV cirrhotic patients as control, and 348 HCV naive patients grouped according to their liver biopsy into; mild (group I) and moderate (group II) fibrosis. They were examined using fibroscan (Echosens, Paris, France, device 502, M probe) before, 12, 24, and 48 weeks of therapy, with 300 patients (150 patients in each group) completed follow-up regardless of their response. The results of fibroscan were compared to each other and to liver biopsy. Results: Fibroscan can diagnose F1 at 6 kPa with 26% sensitivity, 8% specificity, AUC = 0.037; F2 at level of 7 kPa with 84.6% sensitivity, 71.3% specificity, AUC = 0.692 and F3 at 9.5 kPa with 96% sensitivity, 97% specificity, AUC = 0.997. The fibrosis results had regressed significantly after 48 weeks of starting therapy of both patients’ groups (p < 0.05). When categorized by response to therapy, responders showed significant decline in their fibroscan scores compared to non-responders of same fibrosis degree. Conclusion: Fibroscan correlated with histopathology in moderate (F2–F3), but not mild (F1) fibrosis. The degree of fibrosis regresses significantly in HCV responders on anti-viral INF based therapy. Besides its accuracy as noninvasive device in detecting degree of fibrosis, fibroscan can be very useful in assessment of degree of fibrosis during and after therapy.

Keywords

• Transient elastogram
• Fibroscan
• HCV
• Interferon therapy
• Therapy response