Title: Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis
B --- a single-center study with 1,185 liver biopsies as controls
Version: 3 Date: 19 Nov 2021
Reviewer:  Pathik Parikh
Reviewer's report:
The authors have done a commendable job in comparing more than 1000 biopsies from CHB
patients to Fibroscan values. However, it would be worthwhile if authors can provide following
clarity
1. They  found that Inflammationa nd fibrosis correlate. How strong is the correlation, if they
can represent it via a coeeficient of correlation.
2. Since LSM is not specific for inflammation, the rise in LSM values with grades of
inflammation they found, could it be explained just by increase in simultaneous fibrosis
(inflammation and fibrosis correlates as per authors).
3. Could they show that within the same fibrosis stage, different grades of inflammation will
have significant rise in LSM values ?  the current calculations have fibrosis as major confounding
factor.
4. Out of 184 patients with S4 fibrosis - cirrhosis, 183 had G3 or G4 inflammation, which
translates that all patients even after development of cirrhosis, the inflammation remains quite
active, infact higher than non cirrhotic stage. Could authors explain why?
5. Grading of inflammation will have interobserver variability. Did the 2 pathologist saw all
biopsies? what was interobserver variability in these two observers?
6. What could be the reason of under reporting of inflammation when less portal areas (PAs)
were present in liver biopsy? As the size of liver biopsy adequate for ideal characterisation has
been debated, the stark difference that the authors found is quite alarming.
Title: Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis
B --- a single-center study with 1,185 liver biopsies as controls
Version: 3 Date: 19 Nov 2021
Reviewer:  Pathik Parikh
Reviewer's report:
The authors have done a commendable job in comparing more than 1000 biopsies from CHB
patients to Fibroscan values. However, it would be worthwhile if authors can provide following
clarity
1. They  found that Inflammationa nd fibrosis correlate. How strong is the correlation, if they
can represent it via a coeeficient of correlation.
2. Since LSM is not specific for inflammation, the rise in LSM values with grades of
inflammation they found, could it be explained just by increase in simultaneous fibrosis
(inflammation and fibrosis correlates as per authors).
3. Could they show that within the same fibrosis stage, different grades of inflammation will
have significant rise in LSM values ?  the current calculations have fibrosis as major confounding
factor.
4. Out of 184 patients with S4 fibrosis - cirrhosis, 183 had G3 or G4 inflammation, which
translates that all patients even after development of cirrhosis, the inflammation remains quite
active, infact higher than non cirrhotic stage. Could authors explain why?
5. Grading of inflammation will have interobserver variability. Did the 2 pathologist saw all
biopsies? what was interobserver variability in these two observers?
6. What could be the reason of under reporting of inflammation when less portal areas (PAs)
were present in liver biopsy? As the size of liver biopsy adequate for ideal characterisation has
been debated, the stark difference that the authors found is quite alarming.
Please review this paper.
user
Title: Diagnostic efficacy of FibroScan for liver inflammation in patients with chronic hepatitis
B --- a single-center study with 1,185 liver biopsies as controls
Version: 3 Date: 19 Nov 2021
Reviewer:  Pathik Parikh
Reviewer's report:
The authors have done a commendable job in comparing more than 1000 biopsies from CHB
patients to Fibroscan values. However, it would be worthwhile if authors can provide following
clarity
1. They  found that Inflammationa nd fibrosis correlate. How strong is the correlation, if they
can represent it via a coeeficient of correlation.
2. Since LSM is not specific for inflammation, the rise in LSM values with grades of
inflammation they found, could it be explained just by increase in simultaneous fibrosis
(inflammation and fibrosis correlates as per authors).
3. Could they show that within the same fibrosis stage, different grades of inflammation will
have significant rise in LSM values ?  the current calculations have fibrosis as major confounding
factor.
4. Out of 184 patients with S4 fibrosis - cirrhosis, 183 had G3 or G4 inflammation, which
translates that all patients even after development of cirrhosis, the inflammation remains quite
active, infact higher than non cirrhotic stage. Could authors explain why?
5. Grading of inflammation will have interobserver variability. Did the 2 pathologist saw all
biopsies? what was interobserver variability in these two observers?
6. What could be the reason of under reporting of inflammation when less portal areas (PAs)
were present in liver biopsy? As the size of liver biopsy adequate for ideal characterisation has
been debated, the stark difference that the authors found is quite alarming.
assistant