Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracy

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Journal of Hepatology

Volume 54, Issue 4, April 2011, Pages 650-659

--------------------------------------------------------------------------------

doi:10.1016/j.jhep.2010.07.033 | How to Cite or Link Using DOI

European Association for the Study of the Liver Published by

Elsevier Ireland Ltd.

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Research Article

Elastography for the diagnosis of severity of fibrosis in chronic liver disease:

A meta-analysis of diagnostic accuracy

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

E.A. Tsochatzis1, K.S. Gurusamy2, S. Ntaoula1, E. Cholongitas1, B.R. son2

and A.K. Burroughs1, ,

1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, Royal

Free Hospital, London NW3 2QG, UK

2 University Department of Surgery, Royal Free Hospital, London NW3 2QG, UK

Received 11 March 2010; revised 16 July 2010; accepted 20 July 2010.

Available online 24 September 2010.

Background & Aims

Transient elastography is a non-invasive method, for the assessment of hepatic

fibrosis, developed as an alternative to liver biopsy. We studied the

performance of elastography for diagnosis of fibrosis using meta-analysis.

Methods

MEDLINE, EMBASE, SCI, Cochrane Library, conference abstracts books, and article

references were searched. We included studies using biopsy as a reference

standard, with the data necessary to calculate the true and false positive, true

and false negative diagnostic results of elastography for a fibrosis stage, and

with a 3-month maximum interval between tests. The quality of the studies was

rated with the QUADAS tool.

Results

We identified 40 eligible studies. Summary sensitivity and specificity was 0.79

(95% CI 0.74–0.82) and 0.78 (95% CI 0.72–0.83) for F2 stage and 0.83 (95% CI

0.79–0.86) and 0.89 (95% CI 0.87–0.91) for cirrhosis. After an elastography

result at/over the threshold value for F2 or cirrhosis (“positive” result), the

corresponding post-test probability for their presence (if pre-test probability

was 50%) was 78%, and 88% respectively, while, if values were below these

thresholds (“negative” result), the post-test probability was 21% and 16%,

respectively. No optimal stiffness cut-offs for individual fibrosis stages were

validated in independent cohorts and cut-offs had a wide range and overlap

within and between stages.

Conclusions

Elastography theoretically has good sensitivity and specificity for cirrhosis

(and less for lesser degrees of fibrosis); however, it should be cautiously

applied to everyday clinical practice because there is no validation of the

stiffness cut-offs for the various stages. Such validation is required before

elastography is considered sufficiently accurate for non-invasive staging of

fibrosis

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e=rslt_list_item & _srch=doc-info(%23toc%236623%232011%23999459995%233021736%23FLA\

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>

Journal of Hepatology

Volume 54, Issue 4, April 2011, Pages 650-659

--------------------------------------------------------------------------------

doi:10.1016/j.jhep.2010.07.033 | How to Cite or Link Using DOI

European Association for the Study of the Liver Published by

Elsevier Ireland Ltd.

Permissions & Reprints

Research Article

Elastography for the diagnosis of severity of fibrosis in chronic liver disease:

A meta-analysis of diagnostic accuracy

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

E.A. Tsochatzis1, K.S. Gurusamy2, S. Ntaoula1, E. Cholongitas1, B.R. son2

and A.K. Burroughs1, ,

1 The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, Royal

Free Hospital, London NW3 2QG, UK

2 University Department of Surgery, Royal Free Hospital, London NW3 2QG, UK

Received 11 March 2010; revised 16 July 2010; accepted 20 July 2010.

Available online 24 September 2010.

Background & Aims

Transient elastography is a non-invasive method, for the assessment of hepatic

fibrosis, developed as an alternative to liver biopsy. We studied the

performance of elastography for diagnosis of fibrosis using meta-analysis.

Methods

MEDLINE, EMBASE, SCI, Cochrane Library, conference abstracts books, and article

references were searched. We included studies using biopsy as a reference

standard, with the data necessary to calculate the true and false positive, true

and false negative diagnostic results of elastography for a fibrosis stage, and

with a 3-month maximum interval between tests. The quality of the studies was

rated with the QUADAS tool.

Results

We identified 40 eligible studies. Summary sensitivity and specificity was 0.79

(95% CI 0.74–0.82) and 0.78 (95% CI 0.72–0.83) for F2 stage and 0.83 (95% CI

0.79–0.86) and 0.89 (95% CI 0.87–0.91) for cirrhosis. After an elastography

result at/over the threshold value for F2 or cirrhosis (“positive” result), the

corresponding post-test probability for their presence (if pre-test probability

was 50%) was 78%, and 88% respectively, while, if values were below these

thresholds (“negative” result), the post-test probability was 21% and 16%,

respectively. No optimal stiffness cut-offs for individual fibrosis stages were

validated in independent cohorts and cut-offs had a wide range and overlap

within and between stages.

Conclusions

Elastography theoretically has good sensitivity and specificity for cirrhosis

(and less for lesser degrees of fibrosis); however, it should be cautiously

applied to everyday clinical practice because there is no validation of the

stiffness cut-offs for the various stages. Such validation is required before

elastography is considered sufficiently accurate for non-invasive staging of

fibrosis