Value of FibroScan for the Staging of Liver Fibrosis in Chronic Hepatitis B: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGYue-e ¹ , WANGXia ² , XIONGQian ⁴ ,  ZHANGTian-song ⁴

1. Division of Infectious Diseases, Jing'an District Central Hospital, Shanghai 200040, China;
2. Division of Infectious Diseases, Bachu People's Hospital, Bachu 843800, China;
3. Department of Science & Education, Jing'an District Central Hospital, Shanghai 200040, China;
4. Department of TCM, Jing'an District Central Hospital, Shanghai 200040, China;

Corresponding?author：

ZHANGTian-song, Email: ztsdoctor@126.com

Keywords：

FibroScan; Liver fibrosis; Chronic hepatitis B; Diagnostic test; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20150089

Video：

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Objective To systematically review the diagnostic value of FibroScan for the staging of liver fibrosis in chronic hepatitis B. Methods We searched the PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI databases for studies investigated the diagnostic value of FibroScan for hepatic fibrosis B from Jan. 1st, 2003 to Aug. 31st, 2013. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, Stata 13.0 software was used to analyze the data. Results A total of 15 studies involving 2 588 patients were included. The results of meta-analysis showed that:the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the AUC of SROC were 0.77 (95%CI 0.69 to 0.83), 0.84 (95%CI 0.70 to 0.87), 3.8 (95%CI 2.6 to 5.6), 0.29 (95%CI 0.22 to 0.38), 13 (95%CI 8 to 21), 0.82 (95%CI 0.82 to 0.88) for hepatic fibrosis; and were 0.81 (95%CI 0.73 to 0.87), 0.89 (95%CI 0.86 to 0.92), 7.5 (95%CI 5.3 to 10.3), 0.21 (95%CI 0.14 to 0.31), 36 (95%CI 20 to 65), 0.93 (95%CI 0.90 to 0.95) for early hepatic cirrhosis, respectively. Conclusion The current evidence suggests that FibroScan is of good accuracy in the diagnosis of early hepatic fibrosis but not for hepatic cirrhosis in patient with chronic hepatitis B.

Citation： WANGYue-e, WANGXia, XIONGQian, ZHANGTian-song. Value of FibroScan for the Staging of Liver Fibrosis in Chronic Hepatitis B: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(5): 529-536. doi: 10.7507/1672-2531.20150089 Copy

1.	Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography:a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol, 2003, 29(12):1705-1713.
2.	Whiting P, Rutjes AW, Reitsma JB, 等. QUADAS的制定:用于系統評價中評價診斷性研究質量的工具. 中國循證醫學雜志, 2007, 7(4):296-306.
3.	Dwamena B. MIDAS:Stata module for meta-analytical integration of diagnostic test accuracy studies. Available at:http://fmwww.bc.edu/repec/bocode/m/midas.pdf.
4.	Jeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature.Ⅲ. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA, 1994, 271(9):703-707.
5.	Kim BK, Kim HS, Park JY, et al. Prospective validation of ELF test in comparison with Fibroscan and FibroTest to predict liver fibrosis in Asian subjects with chronic hepatitis B. PLoS One, 2012, 7(7):e1964.
6.	Ogawa E, Furusyo N, Murata M, et al. Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis B patients treated with nucleoside analog. Hepatol Res, 2011, 41(12):1178-1188.
7.	Marcellin P, Ziol M, Bedossa P, et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int, 2009, 29(2):242-247.
8.	Chan HL, Wong GL, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat, 2009, 16(1):36-44.
9.	Bonnard P, Sombie R, Lescure FX, et al. Comparison of elastography, serum marker scores, and histology for the assessment of liver fibrosis in hepatitis B virus (HBV)-infected patients in Burkina Faso. Am J Trop Med Hyg, 2010, 82(3):454-458.
10.	Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis:a multicenter prospective study (the FIBROSTIC study). J Hepatol, 2010, 53(6):1013-1021.
11.	Kim DY, Kim SU, Ahn SH, et al. Usefulness of FibroScan for detection of early compensated liver cirrhosis in chronic hepatitis B. Dig Dis Sci, 2009, 54(8):1758-1763.
12.	陳學兵, 朱霞, 陳立宇, 等. 丙氨酸轉氨酶對FibroScan診斷慢性乙型肝炎肝纖維化分期的影響. 中華肝臟病雜志, 2011, 19(4):286-290.
13.	Kim SU, Kim JK, Park YN, et al. Discordance between liver biopsy and FibroScan in assessing liver fibrosis in chronic hepatitis B:risk factors and influence of necroinflammation. PLoS One, 2012, 7(2):e32233.
14.	Zhu X, Wang LC, Chen EQ, et al. Prospective evaluation of FibroScan for the diagnosis of hepatic fibrosis compared with liver biopsy/AST platelet ratio index and FIB-4 in patients with chronic HBV infection. Dig Dis Sci, 2011, 56(9):2742-2749.
15.	Sporea I, Sirli R, Deleanu A, et al. Liver stiffness measurements in patients with HBV vs. HCV chronic hepatitis:a comparative study. World J Gastroenterol, 2010, 16(38):4832-4837.
16.	劉柯慧, 吳海清, 阮雋, 等. Fibroscan在慢性乙型肝炎肝纖維化診斷中的作用及影響因素, 肝臟, 2012, 17(9):621-625.
17.	張旭, 陸偉, 王春妍. Fibroscan對慢性乙型肝炎肝臟纖維化的診斷價值. 天津醫藥, 2011, 39(3):236-238.
18.	紀冬, 邵清, 韓萍, 等. 瞬時彈性成像聯合血清學標志物檢測對肝纖維化的診斷效能分析. 解放軍醫學雜志, 2011, 36(11):1136-1138.
19.	Lesmana CRA, Salim S, Hasan I, et al. Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B:The role in primary care setting. J Clin Pathol, 2011, 64(10):916-920.
20.	張天嵩, 熊茜. HSROC模型在診斷試驗Meta分析中的應用及Stata實現. 循證醫學, 2012, 12(4):241-243, 247.
21.	Talwalkar JA, Kurtz DM, Schoenleber SJ, et al. Ultrasound-based transient elastography for the detection of hepatic fibrosis:systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2007, 5(10):1214-1220.
22.	肝臟硬度評估小組. 瞬時彈性成像技術診斷肝纖維化專家意見. 中華肝臟病雜志, 2013, 21(6):420-424.
23.	Millonig G, Reimann FM,Friedrich S, et al. Extra-hepatic cholestasis increases liver stiffness(FibroScan) irrespective of fibrosis. Hepato, 2008, 48(5):1718-1723.
24.	Coco B, Oliveri F, Malna AM, et al. Transient elastography:a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Hepatol, 2007, 14(5):360-369.
25.	張俊, 徐志偉, 李克. 診斷性試驗Meta分析的效應指標評價. 中國偱證醫學雜志, 2013, 13(07):890-895.

1. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography:a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol, 2003, 29(12):1705-1713.
2. Whiting P, Rutjes AW, Reitsma JB, 等. QUADAS的制定:用于系統評價中評價診斷性研究質量的工具. 中國循證醫學雜志, 2007, 7(4):296-306.
3. Dwamena B. MIDAS:Stata module for meta-analytical integration of diagnostic test accuracy studies. Available at:http://fmwww.bc.edu/repec/bocode/m/midas.pdf.
4. Jeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature.Ⅲ. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA, 1994, 271(9):703-707.
5. Kim BK, Kim HS, Park JY, et al. Prospective validation of ELF test in comparison with Fibroscan and FibroTest to predict liver fibrosis in Asian subjects with chronic hepatitis B. PLoS One, 2012, 7(7):e1964.
6. Ogawa E, Furusyo N, Murata M, et al. Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis B patients treated with nucleoside analog. Hepatol Res, 2011, 41(12):1178-1188.
7. Marcellin P, Ziol M, Bedossa P, et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int, 2009, 29(2):242-247.
8. Chan HL, Wong GL, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat, 2009, 16(1):36-44.
9. Bonnard P, Sombie R, Lescure FX, et al. Comparison of elastography, serum marker scores, and histology for the assessment of liver fibrosis in hepatitis B virus (HBV)-infected patients in Burkina Faso. Am J Trop Med Hyg, 2010, 82(3):454-458.
10. Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis:a multicenter prospective study (the FIBROSTIC study). J Hepatol, 2010, 53(6):1013-1021.
11. Kim DY, Kim SU, Ahn SH, et al. Usefulness of FibroScan for detection of early compensated liver cirrhosis in chronic hepatitis B. Dig Dis Sci, 2009, 54(8):1758-1763.
12. 陳學兵, 朱霞, 陳立宇, 等. 丙氨酸轉氨酶對FibroScan診斷慢性乙型肝炎肝纖維化分期的影響. 中華肝臟病雜志, 2011, 19(4):286-290.
13. Kim SU, Kim JK, Park YN, et al. Discordance between liver biopsy and FibroScan in assessing liver fibrosis in chronic hepatitis B:risk factors and influence of necroinflammation. PLoS One, 2012, 7(2):e32233.
14. Zhu X, Wang LC, Chen EQ, et al. Prospective evaluation of FibroScan for the diagnosis of hepatic fibrosis compared with liver biopsy/AST platelet ratio index and FIB-4 in patients with chronic HBV infection. Dig Dis Sci, 2011, 56(9):2742-2749.
15. Sporea I, Sirli R, Deleanu A, et al. Liver stiffness measurements in patients with HBV vs. HCV chronic hepatitis:a comparative study. World J Gastroenterol, 2010, 16(38):4832-4837.
16. 劉柯慧, 吳海清, 阮雋, 等. Fibroscan在慢性乙型肝炎肝纖維化診斷中的作用及影響因素, 肝臟, 2012, 17(9):621-625.
17. 張旭, 陸偉, 王春妍. Fibroscan對慢性乙型肝炎肝臟纖維化的診斷價值. 天津醫藥, 2011, 39(3):236-238.
18. 紀冬, 邵清, 韓萍, 等. 瞬時彈性成像聯合血清學標志物檢測對肝纖維化的診斷效能分析. 解放軍醫學雜志, 2011, 36(11):1136-1138.
19. Lesmana CRA, Salim S, Hasan I, et al. Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B:The role in primary care setting. J Clin Pathol, 2011, 64(10):916-920.
20. 張天嵩, 熊茜. HSROC模型在診斷試驗Meta分析中的應用及Stata實現. 循證醫學, 2012, 12(4):241-243, 247.
21. Talwalkar JA, Kurtz DM, Schoenleber SJ, et al. Ultrasound-based transient elastography for the detection of hepatic fibrosis:systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2007, 5(10):1214-1220.
22. 肝臟硬度評估小組. 瞬時彈性成像技術診斷肝纖維化專家意見. 中華肝臟病雜志, 2013, 21(6):420-424.
23. Millonig G, Reimann FM,Friedrich S, et al. Extra-hepatic cholestasis increases liver stiffness(FibroScan) irrespective of fibrosis. Hepato, 2008, 48(5):1718-1723.
24. Coco B, Oliveri F, Malna AM, et al. Transient elastography:a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Hepatol, 2007, 14(5):360-369.
25. 張俊, 徐志偉, 李克. 診斷性試驗Meta分析的效應指標評價. 中國偱證醫學雜志, 2013, 13(07):890-895.

Chinese Journal of Evidence-Based Medicine

Value of FibroScan for the Staging of Liver Fibrosis in Chronic Hepatitis B: A Systematic Review

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