Sampling variability of liver fibrosis in chronic hepatitis C
Sampling variability of liver fibrosis in chronic hepatitis C
复制标题
DOI：
10.1016/j.hep.2003.09.022
复制
发表时间：
2003-12-01
期刊：
影响因子：
13.5
通讯作者：
Paradis, V
中科院分区：
文献类型：
--
作者：
Bedossa, P;Dargère, D;Paradis, V
纤维化是慢性丙型肝炎临床试验的常见终点，肝活检仍然是纤维化评估的金标准。然而，肝内纤维化分布的可变性是一个潜在的限制。我们的目的是评估肝纤维化的异质性及其对肝活检评估纤维化准确性的影响。对慢性丙型肝炎患者的手术肝脏标本进行了研究。通过使用图像分析和METAVIR评分（参考值）对整个切片进行纤维化测量。从整个切片的数字化图像中，产生长度增加的虚拟活检标本。对每个单独的虚拟活检标本独立评估纤维化。根据活检标本的长度将结果与参考值进行比较。通过使用图像分析，15 mm长活检标本的纤维化测量变异系数为55%; 25 mm长活检标本的变异系数为45%。通过使用METAVIR评分系统，根据参考值，65%的长度15 mm的活检样本被正确分类。对于25 mm的肝活检标本，这一比例增加至75%，而对于较长的活检标本没有任何实质性益处。纤维化的取样变异性是肝活检评估纤维化的一个重要限制。总之，本研究表明，至少25 mm的长度对于使用半定量评分准确评估纤维化是必要的。当使用更精确的方法（如自动图像分析）时，采样可变性成为一个主要限制。
Fibrosis is a common endpoint of clinical trials in chronic hepatitis C, and liver biopsy remains the gold standard for fibrosis evaluation. However, variability in the distribution of fibrosis within the liver is a potential limitation. Our aim was to assess the heterogeneity of liver fibrosis and its influence on the accuracy of assessment of fibrosis with liver biopsy. Surgical samples of livers from patients with chronic hepatitis C were studied. Measurement of fibrosis was performed on the whole section by using both image analysis and METAVIR score (reference value). From the digitized image of the whole section, virtual biopsy specimens of increasing length were produced. Fibrosis was assessed independently on each individual virtual biopsy specimen. Results were compared with the reference value according to the length of the biopsy specimen. By using image analysis, the coefficient of variation of fibrosis measurement with 15-mm long biopsy specimens was 55%; and for biopsy specimens of 25-mm length it was 45%. By using the METAVIR scoring system, 65% of biopsies 15 mm in length were categorized correctly according to the reference value. This increased to 75% for a 25-mm liver biopsy specimen without any substantial benefit for longer biopsy specimens. Sampling variability of fibrosis is a significant limitation in the assessment of fibrosis with liver biopsy. In conclusion, this study suggests that a length of at least 25 mm is necessary to evaluate fibrosis accurately with a semiquantitative score. Sampling variability becomes a major limitation when using more accurate methods such as automated image analysis.