Can Combinations of Non-Invasive Parameters Replace Liver Biopsy in the Diagnosis of Hepatic Fibrosis in Egyptian Patients with Chronic Hepatitis C

Aims: Liver biopsy has always been represented as the standard reference for assessment of hepatic fibrosis although it has several limitations. This study aimed at evaluating the accuracy of noninvasive methods for diagnosis of hepatic fibrosis in adult Egyptian patients with chronic hepatitis C virus (HCV) infection.
Study Design: Cross sectional study.
Place and Duration of Study: This study was conducted in Al-Ahrar General Hospital (local treatment centre for Hepatitis C virus), Sharkia Governorate, Egypt and the Tropical Medicine Department, Zagazig University Hospitals, Sharkia Governorate, Egypt in the period from April 2011 to March 2012.
Methodology: Fifty chronic HCV patients were selected out of 255 chronic HCV patients awaiting assessment for combined pegylated interferon/ribavirin therapy according to the modified guidelines of the National Committee for Control and Prevention of viral Hepatitis C in Egypt. Diagnosis of HCV was confirmed by detection of anti-HCV antibody and positivity for HCV RNA for more than 6 months. All patients were assessed by liver biopsy and noninvasive methods namely aspartate transaminase/platelet ratio (APRI), abdominal ultrasonography measuring caudate/right lobe ratio and liver stiffness measurement.
Results: The accuracy in diagnosis of liver fibrosis using different methods in comparison to liver biopsy was 60%, 84%, 88%, 90%, 92% and 84% for APRI, ultrasonography, Fibroscan, combined Fibroscan/APRI, Fibroscan/ultrasonography and APRI/ultrasonography respectively. The sensitivity was 62.5%, 87.5%, 87.5%, 90.6%, 93.8 and 87.5 for APRI, ultrasonography, Fibroscan, combined Fibroscan/APRI, Fibroscan/ultrasonography and APRI/ultrasonography respectively. The specificity was 55.6%, 77.8%, 88.9%, 88.9%, 88.9 and 77.8 for APRI, ultrasonography, Fibroscan, combined Fibroscan/APRI, Fibroscan/ultrasonography and APRI/ultrasonography respectively.
Conclusion: Fibroscan appeared superior to APRI score and abdominal ultrasonography in diagnosis of liver fibrosis. Combined Fibroscan /ultrasonography performed better than other combinations for the prediction of significant hepatic fibrosis.