Controlled attenuation parameter for steatosis grading in chronic hepatitis C compared with digital morphometric analysis of liver biopsy: impact of individual elastography measurement quality.

Autor:	Mendes LC; Department of Infectious Diseases, State University of Campinas, Campinas., Ferreira PA; Department of Infectious Diseases, Federal University of São Paulo, Sao Paulo, Brazil., Miotto N; Department of Infectious Diseases, State University of Campinas, Campinas., Zanaga L; Department of Infectious Diseases, State University of Campinas, Campinas., Lazarini MS; Department of Infectious Diseases, State University of Campinas, Campinas., Gonçales ESL; Department of Infectious Diseases, State University of Campinas, Campinas., Pedro MN; Department of Infectious Diseases, State University of Campinas, Campinas., Gonçales FL Júnior; Department of Infectious Diseases, State University of Campinas, Campinas., Stucchi RSB; Department of Infectious Diseases, State University of Campinas, Campinas., Vigani AG; Department of Infectious Diseases, State University of Campinas, Campinas.
Jazyk:	angličtina
Zdroj:	European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2018 Aug; Vol. 30 (8), pp. 959-966.
DOI:	10.1097/MEG.0000000000001145
Abstrakt:	Background and Objective: Controlled attenuation parameter (CAP) diagnostic performance for steatosis grading has been controversial and considerable observer-related variability in liver biopsy has been reported. This is a subanalysis of a larger chronic hepatitis C study on noninvasive fibrosis staging. Materials and Methods: Patients were prospectively enrolled for paired liver biopsy and transient elastography. Biopsy fragments were subjected to digital morphometric steatosis quantification. Associated patient and technical factors, including a newly described elastogram quality score, were evaluated. Results: A total of 312 patients were included in the final analysis. The mean liver stiffness was 8.7±2.1 kPa. Morphometry showed S0 in 19.2% of patients, S1 in 28.5%, S2 in 31.1%, and S3 in 21.2%. CAP showed S0 in 11.2% of patients, S1 in 26.6%, S2 in 56.7%, and S3 in 5.4%. Spearman coefficient showed a positive and independent correlation between CAP and morphometric analysis (r=0.48, P<0.05), except for distinguishing S1 and S2 (P=0.11). Area under the receiver operating characteristic curves for the presence or absence of steatosis was 0.944; differentiation between levels I, II, and III were 0.776, 0.812, and 0.879. Elastogram quality independently predicted accuracy [odds ratio (OR): 6.95, 95% confidence interval (95%CI): 4.45-9.06 as well as CAP interquartile range OR: 2.81, 95%CI: 1.67-3.99] and liver stiffness (OR: 0.78, 95%CI: 0.51-0.80). Conclusion: We present an external validation for CAP against the objective steatosis quantification provided by digital morphometry. Fairly good performance indicators were found, except for S1 versus S2 differentiation. Variability and higher liver stiffness were associated with lower performance. Achieving higher quality measurements, however, overcame such limitations with excellent accuracy.
Databáze:	MEDLINE
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