Hepatology International

, Volume 4, Issue 4, pp 700–706

Liver stiffness measurement in the risk assessment of hepatocellular carcinoma for patients with chronic hepatitis

  • Yuan-Hung Kuo
  • Sheng-Nan Lu
  • Chao-Hung Hung
  • Kwong-Ming Kee
  • Chien-Hung Chen
  • Tsung-Hui Hu
  • Chuan-Mo Lee
  • Chi-Sin Changchien
  • Jing-Houng Wang
Original Article



The risk of hepatocellular carcinoma (HCC) increased with progression of hepatic fibrosis as assessed by liver stiffness measurement (LSM). This study used LSM to assess the risk of HCC presence in patients with chronic hepatitis.


The patients with liver tumor or chronic hepatitis indicated for biopsy were prospectively enrolled. LSM was performed on the same day as biopsy. The diagnostic performances of clinical parameters and LSM in predicting HCC presence were compared with the areas under receiver operating characteristics curves (AUROC). The risk of HCC presence was assessed with stratum-specific likelihood ratios (SSLR). The cut-off values and its diagnostic validity were calculated for LSM.


A total of 435 patients, including 106 HCC and 329 chronic hepatitis, were enrolled. The AUROC in predicting HCC presence was 0.736, 0.733, 0.594, 0.579 and 0.532 for LSM, alpha-fetoprotein, platelet count, total bilirubin, and aspartate aminotransferase–platelet ratio index, respectively. Multivariate analysis showed liver stiffness was an independent factor for HCC presence (odds ratio 1.07, 95% confidence interval (CI) 1.05–1.09). SSLR for HCC presence by liver stiffness was 0.43 (95% CI 0.32–0.57) in <12 kPa, 1.28 (0.89–1.84) in 12–24 kPa, and 5.94 (3.77–9.35) in >24 kPa. With 12 and 24 kPa as the cut-offs in predicting HCC presence, the sensitivity was 69.8 and 41.5%, respectively. The specificity was 69.6 and 92.7%, respectively.


LSM identified the risk group for HCC presence in chronic hepatitis patients and had high specificity in the prediction of HCC with the cut-off of 24 kPa.


Hepatocellular carcinoma Transient elastography Liver stiffness measurement Stratum-specific likelihood ratios (SSLR) 


  1. 1.
    Benvegnu L, Gios M, Boccato S, et al. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut 2004;53:744–749CrossRefPubMedGoogle Scholar
  2. 2.
    Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127:S35–S50CrossRefPubMedGoogle Scholar
  3. 3.
    Yoshida H, Shiratori Y, Moriyama M, et al. Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. IHIT Study Group. Inhibition of Hepatocarcinogenesis by Interferon Therapy. Ann Intern Med 1999;131:174–181PubMedGoogle Scholar
  4. 4.
    Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495–500CrossRefPubMedGoogle Scholar
  5. 5.
    Regev A, Berho M, Jeffers LJ, et al. Sampling error and inter-observer variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97:2614–2618CrossRefPubMedGoogle Scholar
  6. 6.
    Bedossa P, Dalgere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449–1457PubMedGoogle Scholar
  7. 7.
    Piccinino F, Sagnelli E, Pasquale G, et al. Complications following percutaneous liver biopsy: a multicentre retrospective study on 68276 biopsies. J Hepatol 1986;2:165–173CrossRefPubMedGoogle Scholar
  8. 8.
    Foucher J, Chanteloup E, Vergniol J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006;55:403–408CrossRefPubMedGoogle Scholar
  9. 9.
    Fraquelli M, Rigamonti C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007;56:968–973CrossRefPubMedGoogle Scholar
  10. 10.
    Ganne-Carrie N, Ziol M, de Ledinghen V, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology 2006;44:1511–1517CrossRefPubMedGoogle Scholar
  11. 11.
    Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003;29:1705–1713CrossRefPubMedGoogle Scholar
  12. 12.
    Wang JH, Changchien CS, Hung CH, et al. FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis. J Gastroenterol 2009;44:439–446CrossRefPubMedGoogle Scholar
  13. 13.
    Masuzaki R, Tateishi R, Yoshida H, et al. Risk assessment of hepatocellular carcinoma in chronic hepatitis C patients by transient elastography. J Clin Gastroenterol 2008;42:839–843CrossRefPubMedGoogle Scholar
  14. 14.
    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36PubMedGoogle Scholar
  15. 15.
    Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839–843PubMedGoogle Scholar
  16. 16.
    Peirce JC, Cornell RG. Integrating stratum-specific likelihood ratios with the analysis of ROC curves. Med Decis Making 1993;13:141–151CrossRefPubMedGoogle Scholar
  17. 17.
    Furukawa TA, Goldberg DP, Rabe-Hesketh S, et al. Stratum specific likelihood ratios of two versions of the general health questionnaire. Psychol Med 2001;31:519–529CrossRefPubMedGoogle Scholar
  18. 18.
    Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008;134:960–974CrossRefPubMedGoogle Scholar
  19. 19.
    Castéra L, Le Bail B, Roudot-Thoraval F, et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009;50:59–68CrossRefPubMedGoogle Scholar
  20. 20.
    Szabó E, Páska C, Kaposi Novák P, et al. Similarities and differences in hepatitis B and C virus induced hepatocarcinogenesis. Pathol Oncol Res 2004;10:5–11CrossRefPubMedGoogle Scholar
  21. 21.
    Gurtsevitch VE. Human oncogenic viruses: hepatitis B and hepatitis C viruses and their role in hepatocarcinogenesis. Biochemistry (Mosc). 2008;73:504–513CrossRefGoogle Scholar
  22. 22.
    Sagir A, Erhardt A, Schmitt M, et al. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008;47:592–595CrossRefPubMedGoogle Scholar
  23. 23.
    Nahon P, Kettaneha A, Lemoine M, et al. Liver stiffness measurement in patients with cirrhosis and hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2009;21:214–219CrossRefPubMedGoogle Scholar
  24. 24.
    Masuzaki R, Tateishi R, Yoshida H, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology 2009;49:1954–1961CrossRefPubMedGoogle Scholar
  25. 25.
    Del Poggio P, Colombo S. Is transient elastography a useful tool for screening liver disease? World J Gastroenterol 2009;15:1409–1414CrossRefPubMedGoogle Scholar
  26. 26.
    Bruix J, Sherman M, Practice guidelines committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236CrossRefPubMedGoogle Scholar
  27. 27.
    Kudo M, Okanoue T, Japan Society of Hepatology. Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology. Oncology 2007;72:S2–S15CrossRefGoogle Scholar
  28. 28.
    Lu SN, Wang JH, Liu SL, et al. Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high-risk for hepatocellular carcinoma. Cancer 2006;107:2212–2222CrossRefPubMedGoogle Scholar
  29. 29.
    Sinn DH, Paik SW, Kang P, et al. Disease progression and the risk factor analysis for chronic hepatitis C. Liver Int 2008;28:1363–1369CrossRefPubMedGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2010

Authors and Affiliations

  • Yuan-Hung Kuo
    • 1
  • Sheng-Nan Lu
    • 1
  • Chao-Hung Hung
    • 1
  • Kwong-Ming Kee
    • 1
  • Chien-Hung Chen
    • 1
  • Tsung-Hui Hu
    • 1
  • Chuan-Mo Lee
    • 1
  • Chi-Sin Changchien
    • 1
  • Jing-Houng Wang
    • 1
  1. 1.Division of Hepato-Gastroenterology, Department of Internal MedicineChang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of MedicineKaohsiungTaiwan

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