[13] To date, liver biopsy has been the gold standard for assessing the severity of liver fibrosis and cirrhosis,[14] although sampling errors and intraobserver and interobserver variability can lead to understaging.[15, 16] In addition, it is difficult to perform liver biopsy for all patients

because FDA approved Drug Library price of its invasiveness and rare but potentially life-threatening complications.[14] As a result, liver stiffness measurement (LSM), a type of transient elastography, has become a reliable alternative for assessing hepatic fibrosis and cirrhosis mainly in patients with CHC.[17, 18] LSM is non-invasive, reproducible, can be expressed numerically as continuous values, and has a wide dynamic range in the evaluation of hepatic fibrosis. These advantages over liver biopsy suggest the clinical usefulness of LSM for predicting HCC development. Here, we evaluated Sirolimus supplier factors that affect the occurrence of HCC in CHC patients receiving IFN therapy, with a special focus on the predictive value

of LSM. Between October 2007 and April 2011, a total of 207 consecutive CHC patients who underwent a successful LSM and then received IFN-based antiviral therapy at the Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan, were retrospectively enrolled in this study. CHC diagnosis was based on serum HCV-RNA positivity. Exclusion criteria were as follows: (i) hepatitis B surface antigen positivity; (ii) other causes of liver disease of mixed etiologies, including

autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, and Wilson’s disease; (iii) evidence of hepatocellular carcinoma (HCC) on ultrasonography or computed tomography; (iv) previous history of liver transplantation; and (v) treatment for HCC. This study was approved by the Ethics Committee of Juntendo University Shizuoka Hospital in accordance with the Helsinki Declaration, and all patients provided written informed consent. Of these 207 patients, 151 underwent ultrasonography-guided percutaneous liver biopsy within a week before treatment initiation. Liver biopsy specimens see more were embedded in paraffin and stained with hematoxylin-eosin, Azan-Mallory, and reticulin silver impregnation. The specimens were evaluated by an experienced pathologist who was blinded to the patients’ clinical data. Histological evaluation was based on the METAVIR criteria.[19] Hepatic fibrosis was defined as follows: F0, no fibrosis; F1, periportal fibrous expansion; F2, portal fibrous widening with bridging fibrosis; F3, bridging fibrosis with lobular distortion; and F4, liver cirrhosis. On the basis of the degree of lymphocyte infiltration and hepatocyte necrosis, inflammation was scored from A0 to A3, with higher scores indicating more severe inflammation.