Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta-Analysis

Background & Aims: Transient elastography has been studied in a multitude of liver diseases for the staging of liver fibrosis with variable results. A meta-analysis was performed to assess the overall performance of transient elastography for the diagnosis of liver fibrosis and to analyze factors influencing the diagnostic accuracy. Methods: Literature databases and international conference abstracts were searched. Inclusion criteria were as follows: evaluation of transient elastography, liver biopsy as reference, and assessment of the area under the receiver operating characteristic curve (AUROC). The meta-analysis was performed using the random-effects model for the AUROC, summary receiver operating curve techniques, as well as meta-regression approaches. Results: Fifty studies were included in the analysis. The mean AUROC for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.84 (95% confidence interval [CI], 0.82–0.86), 0.89 (95% CI, 0.88–0.91), and 0.94 (95% CI, 0.93–0.95), respectively. For the diagnosis of significant fibrosis a significant reduction of heterogeneity of the AUROC was found when differentiating between the underlying liver diseases (P < .001). Other factors influencing the AUROC were the scoring system used and the country in which the study was performed. Age, body mass index, and biopsy quality did not have a significant effect on the AUROC. Conclusions: Transient elastography can be performed with excellent diagnostic accuracy and independent of the underlying liver disease for the diagnosis of cirrhosis. However, for the diagnosis of significant fibrosis, a high variation of the AUROC was found that is dependent on the underlying liver disease.

Abbreviations used in this paper: ASH, alcoholic steatohepatitis, AUROC, area under the receiver operating characteristic curve, BMI, body mass index, CI, confidence interval, DANA, difference of the mean of advanced and the mean of nonadvanced fibrosis stages, NASH, nonalcoholic steatohepatitis, PBC, primary biliary cirrhosis, PSC, primary sclerosing cholangitis, QUADAS, The Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews, SROC, summary ROC