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Transient elastography accurately diagnoses stage 2 liver fibrosis in patients with chronic hepatitis B

With a sensitivity of 80.6% and a specificity of 82.4%, transient elastography accurately diagnosed stage 2 liver fibrosis in patients with chronic hepatitis B, according to recent findings published in AP&T Alimentary Pharmacology and Therapeutics.

“Our study shows that [transient elastography (TE)], a non-invasive technique, can provide a reliable detection of liver fibrosis in chronic hepatitis B patients and avoid the limitations and complications caused by [liver biopsy (LB)],” the researchers wrote. “TE has been used in the clinical diagnosis of liver fibrosis and performed well as described in many original studies.”

For chronic hepatitis B, the 5-year survival rate is estimated to be between 14% and 35% in untreated patients with decompensated cirrhosis, the researchers wrote. In addition, liver cirrhosis and hepatocellular carcinoma — two conditions that can develop in patients with chronic hepatitis B — cause between 500,000 and 1 million deaths each year. Because of the invasiveness of the LB test, the “gold standard” diagnostic for liver fibrosis, patients often cannot receive multiple biopsies, which is required to monitor the disease. To assess liver stiffness, researchers in France developed the non-invasive TE and the WHO recommended it to diagnose stage 2, 3 and 4 liver fibrosis. However, only a few meta-analyses have assessed TE in chronic hepatitis B patients.

To assess TE for diagnosing stage 2, 3 and 4 liver fibrosis in patients with chronic hepatitis B, the researchers performed a meta-analysis of 27 studies published between 2003 and 2014 that included 4,386 patients, using LB as a reference standard.

For stage 2 liver fibrosis, TE was found to have a sensitivity of .806 (95% CI, .756-.847) and a specificity of .824 (95% CI, .761-.873). For stage 3 liver fibrosis, it had a sensitivity of .819 (95% CI, .748-.874) and a specificity of .866 (95% CI, .824-.899). For stage 4, it had a sensitivity of .863 (95% CI, .818-.898) and a specificity of .875 (95% CI, .84-.903).

“With the use of TE, LB could be reduced,” the researchers wrote. “Further studies are needed to evaluate the effect of alanine transaminase levels on the performance of TE for monitoring liver fibrosis progression.” – by Will Offit

Disclosure: The researchers report that the study was supported by A Major Science and Technology Special Project of China Twelfth Five-year Plan.