Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy length and fragmentation

Summary Background The area under the receiver operating characteristic (ROC) curve is widely used as an estimate of the diagnostic value for fibrosis markers. Biopsy length and fragmentation are known as risk factors of false positive or false negative of biopsy but their quantitative impact on are...

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Published in:Alimentary pharmacology & therapeutics 2007-03, Vol.25 (6), p.733-739
Main Authors: POYNARD, T., HALFON, P., CASTERA, L., CHARLOTTE, F., BAIL, B. LE, MUNTEANU, M., MESSOUS, D., RATZIU, V., BENHAMOU, Y., BOURLIÈRE, M., LEDINGHEN, V. DE
Format: Article
Language:English
Subjects:
Area Under Curve
Biological and medical sciences
Biomarkers
Biopsy, Needle - methods
Biopsy, Needle - standards
Digestive system
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver - pathology
Liver Cirrhosis - pathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Pharmacology. Drug treatments
Sensitivity and Specificity
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Summary:Summary Background The area under the receiver operating characteristic (ROC) curve is widely used as an estimate of the diagnostic value for fibrosis markers. Biopsy length and fragmentation are known as risk factors of false positive or false negative of biopsy but their quantitative impact on area under the receiver operating characteristic curve variability has not been assessed. Aim To assess these relationships to better compare the fibrosis markers. Methods The area under the ROC curves of FibroTest for the diagnosis of fibrosis was estimated in patients with chronic hepatitis C using an integrated database including 1312 patients with FibroTest and biopsy. To take into account the biopsy length, we used two adjustment factors: one in which an observed area under the ROC curve could be adjusted according to the relative area under the receiver operating characteristic curve of a biopsy of a given length vs. the entire liver and one taking into account the prevalence of each fibrosis stage defining advanced and non‐advanced fibrosis. Results The mean biopsy length was smaller for cirrhosis (F4, 16 mm) vs. F3, (18 mm, P = 0.01) and F0 (19 mm, P = 0.01). The mean number of fragments was higher for cirrhosis (F4 = 4.1 fragments) vs. all the other stages (F0 = 1.9, F1 = 1.9, F2 = 1.9, F3 = 2.3; P 
ISSN:0269-2813
1365-2036
DOI:10.1111/j.1365-2036.2007.03252.x