An update on the management of hepatitis C: consensus guidelines from the Canadian Association for the Study of the Liver

2012 Canadian Journal of Gastroenterology 26, 6 (359-375)

TE (FibroScan, Echosens, France) is an ultrasound-based method that measured liver stiffness as a surrogate of liver fibrosis. Numerous studies have validated this tool for staging of fibrosis in patients with chronic hepatitis C and other liver conditions. To obtain accurate TE results, it is important to consider factors that may influence liver stiffness such as nonfibrotic histological lesions (eg, inflammation, vascular congestion and cholestasis) and obesity. In obese patients (body mass index [BMI]  30 kg/m²), it is advisable to use a specifically designed probe (the FibroScan XL probe), which reduces the likelihood of TE failure compared with the standard M probe. Moreover, TE results must be interpreted cautiously when few valid measurements are obtained (ie, < 10 valid shots or success rate < 60%) or when the results are highly variable (ie, interquartile range of measurements over the median value > 30%). [...] Although not universally available, a wealth of literature has now confirmed that serum biomarker panels and TE can be used instead of liver biopsy to stage HCV-related liver fibrosis with acceptable levels of accuracy and reproducibility. In general, these tests are highly accurate for diagnosing cirrhosis and have acceptable, but lower, performance for moderate to severe fibrosis (? F2). The identification of mild fibrosis (F1) and the differentiation between individual stages is poor; these limitations also apply to liver biopsy. The combination of two serum marker panels or TE with a serum marker panel can improve accuracy, although the added cost of his approach requires consideration. Emerging data have also demonstrated a correlation between these tests and clinical outcomes of HCV patients as well as responsiveness to successful viral eradication. Future studies are necessary to determine the minimal clinically important changes on theses markers to facilitate serial monitoring of fibrosis.
Recommendations:
- All patients with HCV should undergo an assessment for the severity of liver fibrosis. Acceptable methods include liver biopsy, elastography (eg, FibroScan) and serum biomarker panels (eg, AST/platelet ratio index, FibroTest, FibroMeter, either alone or in combination (Class 2a, Level B).

Pubmed : 22720279