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REPRODUCIBILITY OF RESULTS

REPRODUCIBILITY OF RESULTS. Hasmik Ghazinyan MD PHD Department of Hepatology Nork Clinical Hospital of Infectious Diseases Armenia. 14 TH APASL STC Liver Fibrosis With and Without Hepatitis C or B Cairo 11-13 June 2014. Liver Fibrosis. Risk of complications.

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REPRODUCIBILITY OF RESULTS

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  1. REPRODUCIBILITY OF RESULTS HasmikGhazinyan MD PHD Department of Hepatology Nork Clinical Hospital of Infectious Diseases Armenia 14TH APASL STC Liver Fibrosis With and Without Hepatitis C or B Cairo 11-13 June 2014

  2. Liver Fibrosis

  3. Risk of complications

  4. Complications of liver biopsy Can We Replace Liver Biopsy with Non-Invasive Procedures?

  5. Serum fibrosis markers • They should be specific hepatic tests • The results should not be influenced by the alteration • of the hepatic, renal or reticuloendothelial function • They should reflect fibrosis regardless of etiology • They should be reproducible and easy to perform • They should be sensitive enough to differentiate • among various fibrosis stages • The risks for patients should be minimum • Afdhal N.H 2007

  6. Comparison of liver biopsy and serum markers of fibrosis • Crockett et all 2006

  7. Reproducibility of Transient Elastography Fraquelli et al, Gut 2007

  8. Table 2 Results of analysis of interobserver agreement Variables ICC (95% Cl) Fraquelli et al, Gut 2007

  9. Advantages and Limitations of Biopsy and Noninvasive Tests • for Detecting Hepatic Fibrosis • Liver Biopsy • Serum Markers • Transient Elastography • MR Elastography

  10. Adapted from Castera and Pinzani (with permission )

  11. Conclusions: • The gold standard for detecting liver fibrosis remains  liver biopsy, despite • its limitations, which needs different  reliable and reproducible alternative • scoring system. • TE is a highly reproducible and user –friendly technique for assessing liver • fibrosis in patients with CLD. However, because TE reproducibility is • significantly reduced (p<0.05) in patients with steatosis, increased BMI and • lower degrees of hepatic fibrosis, caution could be warranted in the • clinical use of TE as surrogate for liver biopsy. • Fibrotest is regarded as noninvasive method with variety of serum markers • for identifying patients who are at the risk for clinically significant hepatic • fibrosis. The patients with hemolysis, cholestasis and Gilbert’s syndrome • could  not be recommended fibrotest. •  Combining methods increase diagnostic accuracy

  12. Recommendations • Liver Biobsy is considered as the gold standard for diagnosing LF, but sampling errors and poor intra and interobserver agreement on biopsy samples lead to poor reproducibility for many liver biopsies and the procededure is invasive and expensive .(A1) • TE is a highly reproducible and user - friendly technique for assessing live fibrosis in patients with CLD .however ,because TE reproducibility is significantly reduced in patients with steatosis, increased BMI lower degrees of hepatic fibrosis and narrow intercostal spaces , caution could be warranted in the clinical use of TE as surrogate for live biopsy.(A1) • Fibrotest Is Regarded As Noninvasive, Attractive And Affordable Methods With Variety Of Serum Makers For Identifying Patients Who Are At The Risk For Clinically Significant HapaticFiberosis . The Patients With Hemolysis, Cholestasis And Gilbert`S Syndrome Could Not Be Recommended Fibrotest.(A1) • Liver biopsy remains an important tool in the evaluation and management of liver disease with its limitations. In fact non-invasive procedures with their disadvantages could not be replaced with liver biopsy. It may take many years , if at all, until liver biopsy will be fully replaced .(A2)

  13. THANK YOU FOR ATTENTION

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