What to expect from FibroScan (transient elastography) for the evaluation of chronic hepatopathies

Currently, liver biopsy is considered to be the gold-standard method for the evaluation of fibrosis in chronic liver disease, but other, non-invasive methods are being developed, among them, liver stiffness (LS) evaluation by means of the FibroScan device. We will present our department’s experience regarding the use of FibroScan in a 10 month period: A. The rate of valid measurements (VM) by FibroScan. Failure to obtain VM of the liver stiffness was observed in 6.9% of the 1461 patients we investigated. Female gender, older age and higher Body Mass Index were statistically significant associated with failure to obtain VM. B. A study comparing the FibroScan results to liver biopsy in patients with chronic hepatitis C showed that for a cut-off value of 6.8 kPa, the LS measurement had a PPV of 97.2%, a NPV of 34.2%, a sensitivity of 59.2%, a specificity of 92.6% for the presence of significant fibrosis (at least F2 Metavir), with a diagnostic performance of 76.1% (AUROC 0,761). C. The FibroScan evaluation of patients with liver cirrhosis proved that LS is a good predictive factor for the presence of cirrhosis, with a sensitivity of approximately 88% for a cut-off value of 14 kPa. Also, we found that the LS was significantly higher in patients with grade II and III EV (that have to be treated with beta-blockers) than in patients without EV or grade I EV (32.9±17.8 kPa vs. 44.4±24.2 kPa, p = 0.0009). In conclusion, transient elastography is a promising method for the evaluation of patients with chronic C viral hepatopathies, enabling an accurate enough staging of liver cirrhosis and the differentiation of mild and no fibrosis (F01) from significant fibrosis (F2-4), important for the decision of antiviral treatment.