# Quantification of Liver Fibrosis--A Comparative Study
## 4 Results and Discussion
### Correlation of Histology Imaging with Non-Invasive Markers of Fibrosis  
The general summary in [PERSON] et al. [35] was that the FibrometerA and Hepascore diagnostic values did not differ from that of FibroTest for advanced fibrosis (AUROC = \(0.83\pm 0.03\)) and cirrhosis, and they were significantly greater than those of APRI, Forns, and FIB4 biomarkers (\(p<0.01\)). Multivariate analysis (MVA) indicated FibroTest as the most informative biomarker, as in patients with chronic viral hepatitis B and C, its prognostic value was similar to that of biopsy samples. [PERSON] et al. [36] found that the total area of fibrosis assessed morphometrically, correlated with Hepascore (r = 0.603, \(p<0.001\)), FibroTest (r = 0.392, \(p=0.03\)), and HBeAg-positive (r = 0.492, \(p=0.001\)) scores only, whereas Hepascore proved to be more accurate compared to the FibroTest and HBeAg-positive biomarkers. [PERSON] et al. [37] showed that the incorporation of microscopy image analysis provided a more complete evaluation of fibrosis. Indeed, a high correlation was observed between the fibrosis index calculated by the DIA quantification technique and the Ishak and METAVIR scores (r = 0.95 and 0.92, respectively, \(p<0.001\)). An excellent intra-observer reproducibility was observed with an intraclass correlation index of 0.99. In [PERSON] et al. [38], a strong correlation was observed between the fibrosis index and the Ishak (r = 0.83), METAVIR (r = 0.86), and Laennec (r = 0.84) HAIs (\(p<0.001\)). The cut-off value associated with cirrhosis was 7.7% and with an AUROC curve of 0.95 (\(p<0.001\)). In addition, the fibrosis index yielded a cut-off value of: (a) 8.9% (AUROC = 0.74), (b) 12% (AUROC = 0.84), and (c) 14% (AUROC = 0.97) for the diagnosis of cirrhotic stages 4a, 4b and 4c, respectively. The [PERSON] et al. [39] MR measures were strongly correlated with those of histology, indicating: (a) r = 0.68, \(p<0.0001\) for fibrosis, (b) r = 0.89, \(p<0.001\) for steatosis, and (c) r = \(-0.69\), \(p<0.0001\) for hemosiderosis. The area under the ROC curve was 0.94, 0.93, and 0.94 for the diagnosis of any degree of fibrosis, steatosis, and hemosiderosis, respectively. In [PERSON] et al. [40], the presence of early significant sinusoidal fibrosis (SF) allowed the identification of 78.9% and 90.6% of patients with fibrosis (F) \(\geq 2\) and HVPG \(\geq 6\) mmHg, respectively, while patients with early SF had older donor age and higher necorinlammatory activity (NIA). More importantly, it was concluded that [PERSON]'s trichrome (MT) staining during the SF classification showed a fair correlation with that of Sirius red (SR) staining (\(p<0.01\)). In [PERSON] et al. [41], the METAVIR fibrosis stages were dichotomized using the CPA and shear wave velocity (SWV). To dichotomize F1 versus F2-F4, the AUROC curves for the CPA was 0.9349 and for SWV equal to 0.8434. This comparison between CPA and SWV showed a correlation of \(p=0.0063\). Respectively for F1, F2 versus F3, F4, the CPA AUROC was 0.9436 and the SWV AUROC was 0.8997 (\(p=0.1587\)). For F1-F3 versus F4, the CPA AUROC was 0.8647, and the SWV AUROC was 0.9036 (\(p=0.2585\)). In [PERSON] et al. [42], the point shear wave elastography (PSWE) values increased according to the severity of hepatic fibrosis, while there were significant differences among fibrosis stages according to the [PERSON] scoring system (\(p<0.05\)). PSWE correlated positively with CPA (r = 0.628, \(p<0.05\)) and showed a more logical relationship with CPA than with the stages evaluated by the Scheuer HAI (r = 0.473, \(p<0.05\)) or the [PERSON] et al. [13] semi-quantitative scoring system (r = 0.487, \(p<0.05\)). [PERSON] et al. 's [43] diagnostic results showed that transient elastography and two-dimensional shear wave elastography (2D-SHE) identified subjects with significant fibrosis (Ishak score \(\geq 3\)) and cirrhosis (Ishak score \(\geq 5\)) with a high-performance level (AUC \(\geq 0.92\)). An important fact is that there was no difference in the diagnostic accuracy between the two techniques.