A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases.
Dr Nathalie Ganne-Carrié and colleagues from France assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis.
The team of doctors conducted a prospective multicenter study 1257 patients with chronic liver diseases of various causes.
|The positive negative predictive value was 96%|
The doctors clarified causes of discrepancies between liver histology and Fibroscan.
The team noted that 132 patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements.
Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population.
The doctors assessed diagnostic accuracy by receiver operator curve analysis.
Liver samples were re-analyzed in case of discrepancies.
The area under the receiver operator curve was 0.95 for the diagnosis of cirrhosis in the patients.
The doctors found that the cutoff value with optimal diagnosis accuracy was about 15 kPa in most patients, with discrepancies among the etiological groups.
The team observed that the positive and negative predictive values were 74% and 96%, respectively.
The doctors noted that 80 patients were misclassified.
Among 45 patients without cirrhosis with liver stiffness of 15 kPa or greater, 27 had extensive fibrosis, and 10 had significant perisinusoidal fibrosis.
The team also observed that among 35 patients with cirrhosis and liver stiffness less than 15 kPa, 10 had a macronodular pattern.
In addition, the team noted that 25 patients of this group, had either none or mild activity.
Dr Ganne-Carrié's team concludes, “Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases.”
“It is better at excluding than at predicting cirrhosis using a threshold of about 15 kPa.”
“False-negatives are mainly attributable to inactive or macronodular cirrhosis.”