P200 Real-life comparison of transient elastography (FibroScan®) to liver biopsies: A UK District General Hospital experience

Background and Aim Over the last decade, the development of liver stiffness measurement using transient elastography (FibroScan®) and its widespread use has become the standard for non-invasive staging of liver fibrosis. Our study explores a real-life experience on concordance of fibrosis staging between the fibroscan and the liver biopsies aiming to assess its reliability. Method We conducted a retrospective study between September 2014 and May 2019 comparing fibroscan and liver biopsy findings. The FibroScan 502 Touch results were interpreted to give the Metavir fibrosis score. Where necessary, the Ishak score of the histology samples was converted to a Metavir equivalent. Discordance was defined as a difference of ≥ 2 stages between the two modalities of staging fibrosis and was analysed using the Chi square test. We analysed the data within a one year duration between the fibroscan and liver biopsy. Results During the study period, an overall total of 199 liver biopsies and 1218 fibroscans were undertaken. Twenty-five patients had both a fibroscan and a liver biopsy performed within a one year interval. The mean and median interval between fibroscan and biopsy was 42 and 28 days respectively. The median fibroscan stage was F3 (range 0–4) and the median liver biopsy stage was F1 (range 0–4). When compared to the liver biopsy, an identical fibroscan based fibrosis score was obtained in 4 (16%) cases. Fibroscan had understaged 2 (8%) and over staged 19 (76%) cases while discordance was noted in 12 (48%) cases (figure 1). Discordance was not statistically different for F0-1 in comparison to F2-4 scores (p=0.311), however, fibroscan score of F0-1 was significantly more likely to have identical value of Metavir score for both fibroscan and liver biopsy (p=0.009) (figure 1). Conclusion Fibroscan with lower fibrosis scores (F0-1) had higher concordance to the liver biopsy based histological staging and therefore can be used safely to exclude significant fibrosis. Moderate to severe fibrosis staging (F2-4) showed increased disparity between the biopsies and the fibroscan scores, with the latter usually over-staging the level of fibrosis. We therefore feel fibroscan in isolation may not be suitable to diagnose advanced liver fibrosis.