Source Liver-Gastroenterology department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, IFR 132, University, Angers; PRES UNAM, France. JeBoursier@chu-angers.fr.

BACKGROUND: The SAFE and Bordeaux Algorithms (BA), which cross-check Fibrotest with 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, then, when needed, the algorithm for F4 ("Successive algorithms"). We aimed to evaluate Successive SAFE, Successive BA, and a new, non-invasive, detailed classification of fibrosis.

METHODS: 1785 patients with chronic hepatitis C, liver biopsy, blood fibrosis tests and Fibroscan (in 729 patients) were included. The most accurate synchronous combination of Fibroscan with a blood test (FibroMeter) provided a new detailed (6 classes) classification (FM+FS).

RESULTS: Successive SAFE had 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% vs 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% vs 34.6% or 24.6%, respectively, p<10(-3) ). The diagnostic accuracy of FM+FS classification (86.7%) was not significantly different from those of Successive SAFE or BA. However, this new classification required no biopsy.

CONCLUSION: 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 non-invasive (0% liver biopsy) and more precise (6 vs 2 or 3 fibrosis classes) fibrosis diagnosis.