World Journal of Medical Sciences 12 (4): 328-335, 2015 ISSN 1817-3055 © IDOSI Publications, 2015 DOI: 10.5829/idosi.wjms.2015.12.4.96147 Corresponding Author: Sahar A. Daoud, Department of Pathology, Faculty of Medicine, BeniSueif University, Egypt. 328 Assessment of Fibrosis in Cases with Hepatitis C Infection; a Comparative Study Between Liver Transient Elastography and Liver Biopsy(using Routine and Immunohistochemical Staining) Samia El-Naggar, Sahar A. Daoud, Kamal A. El-Atrebi and Fouad H. Othman 1 1 2 3 Department of Pathology, Faculty of Medicine, Beni Sueif University, Egypt 1 General Medicine and Hepatology Department, National Hepatology 2 and Tropical Medicine Research Institute, Cairo, Egypt Public Health and Community Department,Taiz University, Yemen 3 Abstract: Hepatitis C virus (HCV) infection and its complications are among the leading public health challenges in the world especially in Egypt. The prognosis and management of chronic liver diseases depend mainly on the amount and progression of liver fibrosis that could be synthesized by the hepatic stellate cells (HSCs). Because of the limitations of liver biopsy, noninvasive alternatives including transient elastography (fibroscan) have been developed. The aim of the work:This study was conducted to compare transient elastography (fibroscan) with histological examination by liver biopsy for the diagnosis of hepatic fibrosis among chronic hepatitis C and to evaluate the role of HSCs in fibrosis using immunostaining in the studied cases.Material and methods: 60 patients were subjected to liver biopsy and fibroscan examination. Liver fibrosis was staged according to the METAVIR system and alpha smooth muscle actin ( -SMA) immunostaining was used to assess the activated hepatic stellate cells (HSCs). The diagnostic performance of fibroscan was assessed by the analysis of the receiver operator characteristics curve (ROC), the sensitivity, the specificity and diagnostic accuracy.Concluding that the major role of transient elastography is the exclusion of cases with bridging fibrosis and cirrhosis. However, it cannot replace biopsy for the diagnosis of significant fibrosis. Hence, transient elastography could be useful in monitoring liver disease and follow up, in cases where liver biopsies are contraindicated. Immunostaining of Hepatic stellate cells by -SMA could shed light to diagnosis of early fibrosis for better therapeutic role in prevention of fibrous tissue formation. Key words: Hepatitis C Elastography Liver Biopsy Fibrosis Hepatic Stellate Cells INTRODUCTION lose their cytoplasmic lipid droplets, forming multiple The stage of liver fibrosis in patients with hepatitis C muscle actin ( -SMA); triggering liver fibrosis [3, 4], these viral infection (HCV) is the most important predictor of cells synthesize collagen types III, IV and in small disease progression that determines the need for antiviral quantities type I, mediated through a series of signaling therapy [1]. Liver fibrosis originally has been thought to molecules released by inflammatory cells, damaged be as a one-way street, now is recognized as a dynamic hepatocytes, Kupffer cells and sinusoidal endothelial process with potential for significant resolution [2]. cells. The proliferation of HSCs results in; increase in type In early stage of HCV infection, the immune system I collagen synthesis and extracellular matrix (ECM) generates antibodies to eradicate the virus, the accumulation, with a reduction in its degradation [4]. hepatocytes are damaged once the infection becomes The first percutaneous liver biopsy (LB) was performed in chronic through direct cellular toxicity and local 1923 and in the past 50 years, it has become the primary stimulation of inflammatory cytokine expression, this tool for diagnosing and staging of liver disease. However, activates hepatic stellate cells (HSCs) that on activation liver biopsy is an invasive and painful procedure it microfilaments that consist mainly of alpha-smooth