Comparison of Fibroscan with Liver biopsy in non-alcoholic fatty liver disease (NAFLD) patients for assessing fibrosis

Abstract

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) in India varies from 9 to 35%. NAFLD is one of the most common causes of chronic liver disease worldwide. Liver biopsy, which is the gold standard for diagnosing NAFLD is an invasive procedure with potential adverse effects and large inter- and intra-observer variability. Hence, various noninvasive markers are being explored to assist in the diagnosis of NAFLD. Fibroscan measures liver stiffness through estimation of the velocity of propagation of a shear wave through liver tissue. Very few studies have addressed the accuracy of fibroscan versus liver biopsy. Objectives: To grade liver fibrosis in the patients and compare fibrosis score by fibroscan with that of liver biopsy in NAFLD. Materials and Methods: An observational study of 72 subjects who had presented with fatty liver on ultrasound and further subjected to fibroscan at the outpatient department of gastroenterology and have undergone liver biopsy (gold standard) for confirmation in the Department of Pathology, Ramaiah Medical College. The study was done from January 2017 to December 2018. After routine processing, liver biopsies were categorized into four subgroups depending on the fibrosis score such as F1 (perivenular fibrosis), F2 (periportal fibrosis), F3 (bridging fibrosis), and F4 (cirrhosis) and was compared with fibroscan scoring, which was based on the degree of fibrosis. Results: Our study revealed that in the subgroup of NAFLD patients with F1, F2, F3 fibrosis on biopsy, the mean fibroscan values were 11.84 ± 9.23, 16.98 ± 18.85, 21.93 ± 5.85, respectively, which overestimate the fibrosis score (2.5–7.5 Kpa), (7.6–10 Kpa), (10.1–13 Kpa), respectively, and in F4 fibrosis, the mean fibroscan value was 33.41 ± 17.39 and in concordance with the fibrosis score (>13 Kpa). Conclusion: Fibroscan overestimates the fibrosis score in the early stages of NAFLD, whereas, it has high accuracy in detecting advanced fibrosis and cirrhosis. Hence, it can be concluded that transient elastography is a good adjunctive tool in NAFLD patients with advanced fibrosis.