Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy.
Τίτλος | Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. |
Publication Type | Journal Article |
Year of Publication | 2011 |
Authors | Tsochatzis, E. A., Gurusamy K. S., Ntaoula S., Cholongitas E., Davidson B. R., & Burroughs A. K. |
Journal | J Hepatol |
Volume | 54 |
Issue | 4 |
Pagination | 650-9 |
Date Published | 2011 Apr |
ISSN | 1600-0641 |
Λέξεις κλειδιά | Biopsy, Chronic Disease, Elasticity Imaging Techniques, Liver, Liver Cirrhosis, Liver Diseases, Severity of Illness Index |
Abstract | 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. |
DOI | 10.1016/j.jhep.2010.07.033 |
Alternate Journal | J. Hepatol. |
PubMed ID | 21146892 |