Spleen stiffness measurement is a promising noninvasive alternative to esophagogastroduodenoscopy that could be used in the diagnosis of esophageal varices in patients with cirrhosis.
However, its overall diagnostic accuracy in various clinical settings is unknown.
Dr Siddharth Singh and colleagues from Minnesota, USA conducted a systematic review and meta-analysis of studies that compared the accuracy of spleen stiffness measurement with that of esophagogastroduodenoscopy in detecting esophageal varices in patients with chronic liver disease.
Through a systematic search of bibliographic databases and conference proceedings, and contact with authors, the researchers identified 12 studies that reported the accuracy of spleen stiffness measurement, compared with esophagogastroduodenoscopy, in the diagnosis of any and/or clinically significant esophageal varices in adults with chronic liver disease.
In a meta-analysis, the team combined measures of test performance of individual studies.
|Using meta-analysis, spleen stiffness measurement detected esophageal varices with 81% sensitivity|
|Clinical Gastroenterology & Hepatology|
Based on pooled estimates, spleen stiffness measurement detected the presence of any esophageal varices with 78% sensitivity, 76% specificity, a positive likelihood ratio of 3.4, a negative likelihood ratio of 0.2, and a diagnostic odds ratio of 19.3.
In a meta-analysis of 9 studies, the team found that spleen stiffness measurement detected the presence of clinically significant esophageal varices with 81% sensitivity, 66% specificity, a positive likelihood ratio of 2.5, a negative likelihood ratio of 0.2, and a diagnostic odds ratio of 12.6.
There was significant heterogeneity among studies owing to differences in elastography techniques and study locations.
Dr Singh and team comment, "Based on a meta-analysis, current techniques for measuring spleen stiffness are limited in their accuracy of esophageal varices diagnosis."
"These limitations preclude widespread use in clinical practice at this time."