Comparison of Transient Elastography and Liver Biopsy in Assessing Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

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Gaurav Bachhav
Lokesh Locheruvapalli Venkateshappa
Balekuduru Avinash
Manjunath Patil
Satyaprakash Bonthala Subbara
Sindhuvalada Karnam Ravikiran


Biopsy, Elasticity imaging techniques, Fibrosis, Liver cirrhosis, Non-alcoholic fatty liver disease


Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Ultrasound-based transient elastography (TE) or TE of the liver is a noninvasive tool for effectively evaluating liver stiffness and fibrosis. The study aimed to compare the accuracy of TE as assessed by Fibroscan with liver biopsy in staging fibrosis in patients with NAFLD. Consecutive NAFLD patients (N = 72) were prospectively enrolled. TE evaluation was performed with Fibroscan and compared with liver biopsy, which is a reference standard. Fibrosis was staged according to the METAVIR scoring system (Meta-analysis of Histological Data in Viral Hepatitis). TE scores and biopsy-related fibrosis stages were correlated. Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of TE was evaluated. Data were analyzed using software R v3.6.3. Liver biopsy showed that 36.11% of patients did not exhibit fibrosis, whereas 25, 16.67, 15.28, and 6.94% of patients had stage F1 (por-tal/mild fibrosis), F2 (periportal/moderate fibrosis), F3 (bridging/severe fibrosis), and F4 (cirrhosis/advanced fibrosis), respectively. TE showed that 50% of patients had cirrhosis, whereas 20.83,15.28, and 13.86% of patients had mild, moderate, and severe fibrosis, respectively. TE had 71% accuracy, 89% sensitivity, and 38% specificity in diagnosing the severity of fibrosis. Hence, it can be implemented as a noninvasive alternative diagnostic tool for understanding the severity of fibrosis in patients with NAFLD. Moreover, it can also be used for quick early diagnosis of NAFLD, reliable staging of fibrosis, and understanding the need for liver transplantation in patients with NAFLD.


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1. Andronescu CI, Purcarea MR, Babes PA. Nonalcoholic fatty liver disease: epidemiology, pathogenesis, and therapeutic impli-cations. J Med Life. 2018;11(1):20–23.
2. Mikolasevic I, Milic S, Wensveen TT, Grgic I, Jakopcic I, Stimac D, et al. Nonalcoholic fatty liver disease – A multisystem disease? World J Gastroenterol. 2016;22(43):9488.
3. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10(11):686–90.
4. Kneeman JM, Misdraji J, Corey KE. Secondary causes of nonalcoholic fatty liver disease. Thera Adv Gastroenterol. 2012;5(3):199–207.
5. Alkhouri N, McCullough AJ. Noninvasive diagnosis of NASH and liver fibrosis within the spectrum of NAFLD. Gastroenterol Hepatol. 2012;8(10):661.
6. National Guideline Centre (UK). Non-Alcoholic Fatty Liver Disease: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2016 Jul. (NICE Guideline, No. 49) Available from:
7. Fallatah HI. Noninvasive biomarkers of liver fibrosis: An overview. Adv Hepatol. 2014;2014:357287.
8. Maklad S, Esmat G, Hassan E, Attalah M, Zeid AA. Liver biopsy and FibroScan to detect early histopathological changes in chronic HBV patients not candidate for treatment. Gastroenterol Res. 2014;7(2):56.
9. El Saadany S, Soliman H, Ziada DH, Hamisa M, Hefeda M, Selim A, et al. Fibroscan versus liver biopsy in the evaluation of response among the Egyptian HCV infected patients to treat-ment. Egypt J Radio Nuc Med. 2016;47(1):1–7.
10. Jamali R, Arj A, Razavizade M, Aarabi MH. Prediction of nonalcoholic fatty liver disease via a novel panel of serum adipokines. Medicine. 2016;95(5): pe2630.
11. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121.
12. Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastog-raphy (FibroScan): A prospective study. Gut. 2016;55(3):403–8.
13. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: A pro-posal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.
14. Pais RA, Lups¸or MO, Poanta? LA, Silaghi AL, Rusu ML, Badea  R, Dumitras¸cu DL. Liver biopsy versus noninvasive methods – Fibroscan and fibrotest in the diagnosis of non-alcoholic fatty liver disease: A review of the literature. Rom J Intern Med. 2009;47(4):331–40.
15. Perumpail BJ, Khan MA, Yoo ER, Cholankeril G, Kim  D, Ahmed A. Clinical epidemiology, and disease burden of nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(47):8263.
16. Tovo CV, Villela-Nogueira CA, Leite NC, Panke CL, Port GZ, Fernandes S, et al. Transient hepatic elastography has the best performance to evaluate liver fibrosis in non-alcoholic fatty liver disease (NAFLD). Ann Hepatol. 2019;18(3):445–9.
17. Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Caspian J Intern Med. 2016;7(4):242.
18. Vispo E, Barreiro P, Del Valle J, Maida I, de Ledinghen V, Quereda C, et al. Overestimation of liver fibrosis staging using transient elastography in patients with chronic hepatitis C and significant liver inflammation. Antivir Ther. 2009;14(2):187–93.
19. Lucidarme D, Foucher J, Le Bail B, Vergniol J, Castera L, Duburque C, et al. Factors of accuracy of transient elastography (fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C. Hepatol. 2006; 49(4):1083–9.
20. Sporea I, S¸irli R, Deleanu A, Tudora A, Curescu M, Cornianu  M, Laza?r D. Comparison of the liver stiffness measurement by transient elastography with the liver biopsy. World J Gastroenterol. 2008;14(42):6513–17.
21. Fujimori N, Tanaka N, Shibata S, Sano K, Yamazaki T, Sekiguchi T, et al. Controlled attenuation parameter is cor-related with actual hepatic fat content in patients with non-alcoholic fatty liver disease with none-to-mild obesity and liver fibrosis. Hepatol Res. 2016;46(10):1019–27. http://dx.doi. org/10.1111/hepr.12649
22. Foucher J, Castéra L, Bernard PH, Adhoute X, Laharie D, Bertet J, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol. 2016;18(4):411–12.
23. Angulo P. Nonalcoholic fatty liver disease. N Eng J Med. 2002;346(16):1221–31. NEJMra011775
24. Farrell GC. Non-alcoholic steatohepatitis: What is it, and why is it important in the Asia–Pacific region? J Gastroenterol Hepatol. 2003;18(2):124–38.
25. Bang KB, Cho YK. Comorbidities and metabolic derange-ment of NAFLD. J Lifestyle Med. 2015;5(1):7.
26. Corey KE, Vuppalanchi R. Assessment, and management of comorbidities (including cardiovascular disease) in patients with nonalcoholic fatty liver disease. Clin Liver Dis. 2012;1(4):114.
27. Fibroscan predicts liver disease progression better than biopsy [Internet]. 2013. Available from:
28. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Eng J Med. 2011;344(7):495–500. 53440706
29. Zachry WM. Abstract 27. Presented at: American College of Gastroenterology Annual Scientific Meeting; Philadelphia, PA; 2017.
30. Al Ghamdi MH, Fallatah HI, Akbar HO. Transient elastography (Fibroscan) compared to diagnostic endoscopy in the diagnosis of varices in patients with cirrhosis. Science. 2016;5(6):55–9.
31. Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: Results of a prospective nationwide survey. Hepatol. 2003;32(3):477–81.
32. Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol Hepatol. 2000;14(6):543–8. http://dx.doi. org/10.1155/2000/107982