Correlation of Fibroscan with Liver Biopsy in Malignant Biliary Obstruction

Naren K A, MS, Thakur D Yadav, MS, Vikas Gupta, Mch, SGE, Ashim Das, MD, Virendra Singh, MD, Saroj K Sinha, DM. PGIMER Chandigarh

OBJECTIVES:

The Objective was to see the sensitivity and specificity of fibroscan in detecting biliary cirrhosis secondary to malignant biliary obstruction. A secondary objective was to correlate fibroscan with liver biopsy, so as to avoid the invasive liver biopsy in future.

METHODS AND PROCEDURES:

In our study all the patients with unresectable disease underwent a  percutaneous core liver biopsy ( under local anesthesia)  and  in resectable patients undergoing Surgery (under General Anesthesia) , a core biopsy of the normal liver parenchyma was taken as a part of the primary procedure planned . The staging system  (ISHAK’s Modified Histological Activity Index ) was used to assess the severity of fibrosis  Fibroscan was performed in all the patients The probe was placed at the intercostal space overlying the liver with the patient in supine position in right arm abduction. Ten validated measurements were taken, with the median value taken as the final result, The values thus measured in these studies were then categorized into different LSM Fibrosis stage.

RESULTS: 

Our study showed that Fibroscan is a very sensitive tool in picking up High stage (3 and 4) fibrosis and thus influence treatment management in such patients. In our study the Sensitivity of Fibroscan in detecting Stage III and IV fibrosis was 100 % with the specificity at 64.2 %. Prolonged cholestasis also influences Fibroscan and hence overpredicts the Fibrosis stage. In our study, 2/5 patients of stage III and 5/9 patients of Stage II biopsy proven fibrosis were overpredicted by fibroscan. About 77 % of them had cholestasis in the Histopathological report.As there is no universality in the reference range used for measuring and grading liver fibrosis by Fibroscan( Disease to Disease variation), an Universal consensus should be arrived at, for implementation of common reference ranges which can be projected onto the population for general use.

CONCLUSION:

Our study showed that Fibroscan is a very sensitive tool in determining the Liver Fibrosis especially in high grade fibrosis ( Stage III and Stage IV ). Documentation of Cirrhosis ( Stage IV) or a pre cirrhotic stage ( Stage III) by Fibroscan helps us offer a less radical surgery for patients with Malignant Obstructive Jaundice and hence reduces post op Morbidity and Adverse Liver events. Also it is easily measurable and reproducible and hence Fibroscan offers a noninvasive alternative to Liver biopsy, thereby avoiding its various complications.