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

Articles in Press

E.A. Tsochatzis 1, K.S. Gurusamy 2, S. Ntaoula 1, E. Cholongitas 1, B.R. Davidson 2, A.K. Burroughs 1

Received 11 March 2010; received in revised form 16 July 2010; accepted 20 July 2010. published online 30 November 2010.
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Background & Aims
Transient elastography is a non-invasive method of assessing hepatic fibrosis developed as an alternative to liver biopsy. We assessed 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. Quality of 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.

Conclusion
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.

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

Corresponding author. Address: The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK. Tel.: +44 2074726229; fax: +44 2074726226.

PII: S0168-8278(10)00825-1
doi:10.1016/j.jhep.2010.07.033
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

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