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Precise evaluation of liver histology by computerized morphometry shows that steatosis influences liver stiffness measured by transient elastography in chronic hepatitis C

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Liver stiffness evaluation (LSE) by Fibroscan is now widely used to assess liver fibrosis in chronic hepatitis C. Liver steatosis is a common lesion in chronic hepatitis C as in other chronic liver diseases, but its influence on LSE remains unclear. We aimed to precisely determine the influence of steatosis on LSE by using quantitative and precise morphometric measurements of liver histology.

Methods

650 patients with chronic hepatitis C, liver biopsy, and LSE were included. Liver specimens were evaluated by optical analysis (Metavir F and A, steatosis grading) and by computerized morphometry to determine the area (%, reflecting quantity) and fractal dimension (FD, reflecting architecture) of liver fibrosis and steatosis.

Results

The relationships between LSE and liver histology were better described using morphometry. LSE median was independently linked to fibrosis (area or FD), steatosis (area or FD), activity (serum AST), and IQR/LSE median. Steatosis area ≥4.0 % induced a 50 % increase in LSE result in patients with fibrosis area <9 %. In patients with IQR/LSE median ≤0.30, the rate of F0/1 patients misclassified as F ≥ 2 by Fibroscan was, respectively for steatosis area <4.0 and ≥4.0 %: 12.6 vs 32.4 % (p = 0.003). Steatosis level did not influence LSE median when fibrosis area was ≥9 %, and consequently did not increase the rate of F ≤ 3 patients misclassified as cirrhotic.

Conclusion

A precise evaluation of liver histology by computerized morphometry shows that liver stiffness measured by Fibroscan is linked to liver fibrosis, activity, and also steatosis. High level of steatosis induces misevaluation of liver fibrosis by Fibroscan.

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Abbreviations

LSE:

Liver stiffness evaluation

FD:

Fractal dimension

IQR/M:

Interquartile range/median

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

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Acknowledgments

We thank the following contributors: Gilles Hunault, Pascal Veillon, Gwenaëlle Soulard; and Kevin L. Erwin (for English proofreading). This work was financially supported by PAI Volubilis, ANRS (French National Agency for AIDS and Viral Hepatitis) for HC/EP23 FIBROSTAR, University Hospital of Angers.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Liver-Gastroenterology Department, University Hospital, Angers, France

    Jérôme Boursier, Frédéric Oberti, Isabelle Fouchard-Hubert, Nina Dib & Paul Calès

  2. HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France

    Jérôme Boursier, Julien Chaigneau, Yves Gallois, Frédéric Oberti, Isabelle Fouchard-Hubert, Sandrine Bertrais, Marie-Christine Rousselet & Paul Calès

  3. Liver-Gastroenterology Department, Haut-Lévêque University Hospital, Pessac, Bordeaux, France

    Victor de Ledinghen

  4. INSERM U889, Victor Segalen University, Bordeaux, France

    Victor de Ledinghen

  5. Pathology Department, University Hospital, Grenoble, France

    Nathalie Sturm

  6. Liver-Gastroenterology Department, Mohammed 5 Souissi University, Rabat, Morocco

    Laïla Amrani

  7. Liver-Gastroenterology Department, University Hospital, Tours, France

    Yannick Bacq

  8. Pathology Department, University Hospital, Angers, France

    Jérémy Sandrini, Julien Chaigneau & Marie-Christine Rousselet

  9. Pathology Department, University Hospital, Bordeaux, France

    Brigitte Le Bail

  10. Liver-Gastroenterology Department, University Hospital, Grenoble, France

    Jean-Pierre Zarski & Vincent Leroy

  11. INSERM/UJF U823, IAPC, IAB, Grenoble, France

    Jean-Pierre Zarski & Vincent Leroy

  12. Biochemistry Department, University Hospital, Angers, France

    Yves Gallois

  13. Pathology Department, Mohammed 5 Souissi University, Rabat, Morocco

    Zaytouna Al Hamany

  14. Service d’Hépato-Gastroentérologie, CHU, 49933, Angers Cedex 09, France

    Jérôme Boursier

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  1. Jérôme Boursier
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Consortia

Multicentre group ANRS HC EP23 FIBROSTAR

Corresponding author

Correspondence to Jérôme Boursier.

Additional information

Members of the Multicentre group ANRS HC EP23 FIBROSTAR are given in the Appendix.

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FIBROSTAR study

FIBROSTAR study

Hepatologists: R. Poupon, A. Poujol, Saint-Antoine, Paris; A. Abergel, Clermont-Ferrand; J.P. Bronowicki, Nancy; J.P. Vinel, S. Metivier, Toulouse; V. de Ledinghen, J. Foucher, J. Vergniol, Bordeaux; O. Goria, Rouen; M. Maynard-Muet, C. Trepo, Lyon; Ph. Mathurin, Lille; D. Guyader, H. Danielou, Rennes; O. Rogeaux, Chambéry; S. Pol, Ph. Sogni, Cochin, Paris; A. Tran, Nice; P. Calès, Angers; P. Marcellin, T. Asselah, Clichy; M. Bourliere, V. Oulès, Saint Joseph, Marseille; D. Larrey, Montpellier; F. Habersetzer, Strasbourg; M. Beaugrand, Bondy; V Leroy, MN Hilleret, Grenoble.

Biologists: R-C. Boisson, Lyon Sud; M-C. Gelineau, B. Poggi, Hôtel Dieu, Lyon; J-C. Renversez, Candice Trocmé, Grenoble; J. Guéchot, R. Lasnier, M. Vaubourdolle, Paris; H. Voitot, Beaujon, Paris; A. Vassault, Necker, Paris; A. Rosenthal-Allieri, Nice; A. Lavoinne, F. Ziegler, Rouen; M. Bartoli, C. Lebrun, Chambéry; A. Myara, Paris Saint-Joseph; F. Guerber, A. Pottier, Elibio, Vizille. MC Beauvieux, Bordeaux.

Pathologists: E-S. Zafrani, Créteil; N. Sturm, Grenoble.

Methodologists: A. Bechet, J-L Bosson, A. Paris, S. Royannais, CIC, Grenoble; A. Plages, Grenoble.

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Boursier, J., de Ledinghen, V., Sturm, N. et al. Precise evaluation of liver histology by computerized morphometry shows that steatosis influences liver stiffness measured by transient elastography in chronic hepatitis C. J Gastroenterol 49, 527–537 (2014). https://doi.org/10.1007/s00535-013-0819-9

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