Interobserver variability in transient elastography analysis of patients with chronic hepatitis C

Area of Science:

• Hepatology
• Medical Imaging
• Diagnostic Techniques

Background:

• Transient elastography (TE) is a non-invasive method for assessing hepatic fibrosis.
• Interobserver variability in TE has raised concerns regarding its reliability in fibrosis evaluation.
• Chronic hepatitis C (CHC) management relies on accurate fibrosis staging.

Purpose of the Study:

• To evaluate the interobserver variation in transient elastography measurements for liver stiffness in patients with CHC.
• To assess the reliability of TE in staging liver fibrosis and screening for oesophageal varices.

Main Methods:

• A cross-sectional study involving two experienced operators assessing 195 CHC patients using TE.
• Liver stiffness measurements were categorized into METAVIR fibrosis stages (F0-F4).
• Interobserver agreement was analyzed using intraclass correlation coefficient (ICC) and Cohen's kappa (κ).

Main Results:

• High correlation between operators (ICC=0.940, Spearman's ρ=0.924).
• Significant discordance observed: 35% for at least one fibrosis stage and 5% for two or more stages.
• Considerable interobserver variability in identifying patients needing oesophageal varices screening (κ values ranging from 0.13 to 0.61).

Conclusions:

• While TE shows high measurement correlation, significant interobserver variability exists.
• TE alone is not recommended as a sole screening tool for oesophageal varices in CHC patients.
• Further standardization or complementary methods may be needed to improve TE reliability.