Department of Hepatogastroenterology, University Hospital, Angers, France.
Hepatology. 2012 Jan;55(1):58-67. doi: 10.1002/hep.24654.
The sequential algorithm for fibrosis evaluation (SAFE) and the Bordeaux algorithm (BA), which cross-check FibroTest with the aspartate aminotransferase-to-platelet ratio index (APRI) or FibroScan, are very accurate but provide only a binary diagnosis of significant fibrosis (SAFE or BA for Metavir F ≥ 2) or cirrhosis (SAFE or BA for F4). Therefore, in clinical practice, physicians have to apply the algorithm for F ≥ 2, and then, when needed, the algorithm for F4 ("successive algorithms"). We aimed to evaluate successive SAFE, successive BA, and a new, noninvasive, detailed classification of fibrosis. The study included 1785 patients with chronic hepatitis C, liver biopsy, blood fibrosis tests, and FibroScan (the latter in 729 patients). The most accurate synchronous combination of FibroScan with a blood test (FibroMeter) provided a new detailed (six classes) classification (FM+FS). Successive SAFE had a significantly (P < 10(-3) ) lower diagnostic accuracy (87.3%) than individual SAFE for F ≥ 2 (94.6%) or SAFE for F4 (89.5%), and required significantly more biopsies (70.8% versus 64.0% or 6.4%, respectively, P < 10(-3) ). Similarly, successive BA had significantly (P ≤ 10(-3) ) lower diagnostic accuracy (84.7%) than individual BA for F ≥ 2 (88.3%) or BA for F4 (94.2%), and required significantly more biopsies (49.8% versus 34.6% or 24.6%, respectively, P < 10(-3) ). The diagnostic accuracy of the FM+FS classification (86.7%) was not significantly different from those of successive SAFE or BA. However, this new classification required no biopsy.
SAFE and BA for significant fibrosis or cirrhosis are very accurate. However, their successive use induces a significant decrease in diagnostic accuracy and a significant increase in required liver biopsy. A new fibrosis classification that synchronously combines two fibrosis tests was as accurate as successive SAFE or BA, while providing an entirely noninvasive (0% liver biopsy) and more precise (six versus two or three fibrosis classes) fibrosis diagnosis.
纤维化评估序贯算法（SAFE）和波尔多算法（BA）通过天冬氨酸氨基转移酶-血小板比值指数（APRI）或 FibroScan 对 FibroTest 进行交叉检查，非常准确，但只能对显著纤维化（SAFE 或 BA 为 Metavir F ≥ 2）或肝硬化（SAFE 或 BA 为 F4）进行二进制诊断。因此，在临床实践中，医生必须应用 F ≥ 2 的算法，然后在需要时应用 F4 的算法（“序贯算法”）。我们旨在评估序贯 SAFE、序贯 BA 和一种新的非侵入性、详细的纤维化分类。该研究包括 1785 例慢性丙型肝炎患者，他们接受了肝活检、血液纤维化检测和 FibroScan（后者在 729 例患者中进行）。与血液检测（FibroMeter）同步结合最准确的 FibroScan 提供了一种新的详细（六级）分类（FM+FS）。序贯 SAFE 的诊断准确性明显低于单个 SAFE 对 F ≥ 2（94.6%）或 SAFE 对 F4（89.5%）（P<10(-3)），并且需要进行明显更多的活检（分别为 70.8%、64.0%或 6.4%，P<10(-3)）。同样，序贯 BA 的诊断准确性明显低于单个 BA 对 F ≥ 2（88.3%）或 BA 对 F4（94.2%）（P≤10(-3)），并且需要进行明显更多的活检（分别为 49.8%、34.6%或 24.6%，P<10(-3)）。FM+FS 分类的诊断准确性与序贯 SAFE 或 BA 无显著差异。然而，这种新的分类不需要进行活检。
显著纤维化或肝硬化的 SAFE 和 BA 非常准确。然而，它们的连续使用会导致诊断准确性显著下降，需要进行更多的肝活检。一种新的纤维化分类方法，它同步结合了两种纤维化检测方法，与序贯 SAFE 或 BA 一样准确，同时提供了完全非侵入性（0%肝活检）和更精确（六级与两级或三级纤维化分类）的纤维化诊断。
