Objectives: The use of transient elastography to assess liver stiffness measurement (LSM) has now become widely available for the diagnosis of liver fibrosis as a rapid, noninvasive test (it is still not approved for use in the United States). It has previously been showed as an accurate method of representing the state of liver fibrosis with concomitant evaluation of liver biopsy and the histologic scoring system METAVIR. We performed a meta-analysis to further assess its use in comparison with liver biopsy.
Methods: Studies from the literature were analyzed with a median liver stiffness value in kilopascal given for fibrosis stages according to histopathologic findings on biopsy and best discriminant cutoff levels in kilopascals for significant fibrosis (≥F2) and cirrhosis (F4).
Results: A total of 22 studies were selected comprising 4430 patients; chronic hepatitis C infection was the most common etiology of fibrosis. The pooled estimates for significant fibrosis (≥F2) measured 7.71 kPa (LSM cutoff value) with a sensitivity of 71.9% [95% confidence interval (CI): 71.4%-72.4%] and specificity of 82.4% (95% CI: 81.9-82.9%), whereas for cirrhosis (F4) the results showed a cutoff of 15.08 kPa with a sensitivity of 84.45% (95% CI: 84.2-84.7%) and specificity of 94.69% (95% CI: 94.3%-95%).
Conclusions: Further evaluation of transient elastography to assess LSM is required in prospective studies to potentially increase the sensitivity and establish its clinical utility.
Departments of HIV Medicine and Gastroenterology, Chelsea and Westminster Hospital, St Stephen's Centre, Imperial College School of Medicine, London, UK
Funding declaration: none.
Reprints: Justin Stebbing, MA, MRCP, FRCPath, PhD, Imperial College School of Medicine, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK (e-mail firstname.lastname@example.org).
Received for publication February 28, 2009
accepted June 24, 2009
Justin Stebbing, George Panos, and Lavanta Farouk are equal contributors.
Conflict of interest: none.