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Published in: Hepatology International 4/2015

01-10-2015 | Original Article

Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: a systematic review and meta-analysis of a diagnostic test

Authors: Xueying Xu, Yang Su, Ruixiang Song, Yang Sheng, Wensi Ai, Xiaofei Wu, Hongbo Liu

Published in: Hepatology International | Issue 4/2015

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Abstract

Introduction

Transient elastography has good diagnostic accuracy for predicting fibrosis and cirrhosis related to hepatitis B virus. However, the enrolled subjects in some studies have also included chronic hepatitis B patients with chronic hepatitis C coinfection or other etiologies of liver diseases. This might under- or overestimate the role of transient elastography in chronic hepatitis B patients.

Methods

A systematic review was conducted on records in PubMed, EMBASE and the Cochrane Library electronic databases until 31 December 2013. We systematically assessed the effectiveness and accuracy of transient elastography for predicting the fibrosis and cirrhosis of the single hepatitis B virus. The questionnaire for quality assessment of diagnostic accuracy studies was used.

Results

In this meta-analysis, out of 257 articles evaluated for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis. Eventually, our final data set for the meta-analysis contained 19 studies. The areas under the summary receiver-operating characteristic curve for transient elastography of significant fibrosis and cirrhosis were 0.8225 and 0.9108, respectively. The pooled diagnostic odds ratios for transient elastography of significant fibrosis and cirrhosis were 11.19 (95 % CI 6.63–18.89) and 26.87 (95 % CI 17.88–40.38), respectively. In Europe, the areas of significant fibrosis and cirrhosis were 0.803 and 0.905; those in Asia were 0.871 and 0.914, respectively.

Conclusions

Based on this meta-analysis we claim that liver stiffness measurement using transient elastography has good diagnostic accuracy for predicting single hepatitis B virus-related significant fibrosis and cirrhosis, especially in Asian populations.
Literature
2.
go back to reference Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97–107CrossRefPubMed Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97–107CrossRefPubMed
3.
go back to reference Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol 2004;38:S158–S168CrossRefPubMed Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol 2004;38:S158–S168CrossRefPubMed
4.
go back to reference Gumusay O, Ozenirler S, Atak A, Sonmez C, Ozkan S, Tuncel AF, et al. Diagnostic potential of serum direct markers and non-invasive fibrosis models in patients with chronic hepatitis B. Hepatol Res 2013;43:228–237CrossRefPubMed Gumusay O, Ozenirler S, Atak A, Sonmez C, Ozkan S, Tuncel AF, et al. Diagnostic potential of serum direct markers and non-invasive fibrosis models in patients with chronic hepatitis B. Hepatol Res 2013;43:228–237CrossRefPubMed
5.
go back to reference Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531CrossRefPubMed Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531CrossRefPubMed
7.
go back to reference Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003;39:239–244CrossRefPubMed Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003;39:239–244CrossRefPubMed
8.
go back to reference Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005;128:343–350CrossRefPubMed Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005;128:343–350CrossRefPubMed
9.
go back to reference Nahon P, Thabut G, Ziol M, Htar MT, Cesaro F, Barget N, et al. Liver stiffness measurement versus clinicians’ prediction or both for the assessment of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 2006;101:2744–2751CrossRefPubMed Nahon P, Thabut G, Ziol M, Htar MT, Cesaro F, Barget N, et al. Liver stiffness measurement versus clinicians’ prediction or both for the assessment of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 2006;101:2744–2751CrossRefPubMed
10.
go back to reference Kettaneh A, Marcellin P, Douvin C, Poupon R, Ziol M, Beaugrand M, et al. Features associated with success rate and performance of FibroScan measurements for the diagnosis of cirrhosis in HCV patients: a prospective study of 935 patients. J Hepatol 2007;46:628–634CrossRefPubMed Kettaneh A, Marcellin P, Douvin C, Poupon R, Ziol M, Beaugrand M, et al. Features associated with success rate and performance of FibroScan measurements for the diagnosis of cirrhosis in HCV patients: a prospective study of 935 patients. J Hepatol 2007;46:628–634CrossRefPubMed
11.
go back to reference Kim SU, Lee JH, do Kim Y, Ahn SH, Jung KS, Choi EH, et al. Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis. PLoS One 2012;7:e36676PubMedCentralCrossRefPubMed Kim SU, Lee JH, do Kim Y, Ahn SH, Jung KS, Choi EH, et al. Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis. PLoS One 2012;7:e36676PubMedCentralCrossRefPubMed
12.
go back to reference Chon YE, Choi EH, Song KJ, Park JY, do Kim Y, Han KH, et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS One 2012;7:e44930PubMedCentralCrossRefPubMed Chon YE, Choi EH, Song KJ, Park JY, do Kim Y, Han KH, et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS One 2012;7:e44930PubMedCentralCrossRefPubMed
13.
go back to reference Piscaglia F, Marinelli S, Bota S, Serra C, Venerandi L, Leoni S, et al. The role of ultrasound elastographic techniques in chronic liver disease: current status and future perspectives. Eur J Radiol 2014;83:450–455CrossRefPubMed Piscaglia F, Marinelli S, Bota S, Serra C, Venerandi L, Leoni S, et al. The role of ultrasound elastographic techniques in chronic liver disease: current status and future perspectives. Eur J Radiol 2014;83:450–455CrossRefPubMed
14.
go back to reference Fraquelli M, Branchi F. The role of transient elastography in patients with hepatitis B viral disease. Dig Liver Dis 2011;43(Suppl 1):S25–S31CrossRefPubMed Fraquelli M, Branchi F. The role of transient elastography in patients with hepatitis B viral disease. Dig Liver Dis 2011;43(Suppl 1):S25–S31CrossRefPubMed
15.
go back to reference Adebajo CO, Talwalkar JA, Poterucha JJ, Kim WR, Charlton MR. Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: a systematic review and meta-analysis. Liver Transpl 2012;18:323–331CrossRefPubMed Adebajo CO, Talwalkar JA, Poterucha JJ, Kim WR, Charlton MR. Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: a systematic review and meta-analysis. Liver Transpl 2012;18:323–331CrossRefPubMed
16.
go back to reference Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25PubMedCentralCrossRefPubMed Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25PubMedCentralCrossRefPubMed
17.
go back to reference Group TFMCS. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994;20:15–20CrossRef Group TFMCS. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994;20:15–20CrossRef
18.
go back to reference Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 1995;19:1409–1417CrossRefPubMed Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 1995;19:1409–1417CrossRefPubMed
19.
go back to reference Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 1991;13:372–374CrossRefPubMed Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 1991;13:372–374CrossRefPubMed
20.
go back to reference Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696–699CrossRefPubMed Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696–699CrossRefPubMed
21.
go back to reference Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004;39:1147–1171CrossRefPubMed Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004;39:1147–1171CrossRefPubMed
23.
go back to reference Goyal R, Mallick SR, Mahanta M, Kedia S, Shalimar, Dhingra R et al. Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B. J Gastroenterol Hepatol 2013;28:1738–1745 Goyal R, Mallick SR, Mahanta M, Kedia S, Shalimar, Dhingra R et al. Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B. J Gastroenterol Hepatol 2013;28:1738–1745
24.
go back to reference Kim BK, Kim HS, Park JY, do Kim Y, Ahn SH, Chon CY, 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:e41964PubMedCentralCrossRefPubMed Kim BK, Kim HS, Park JY, do Kim Y, Ahn SH, Chon CY, 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:e41964PubMedCentralCrossRefPubMed
25.
go back to reference Kim BK, Kim SU, Kim HS, Park JY, Ahn SH, Chon CY, et al. Prospective validation of FibroTest in comparison with liver stiffness for predicting liver fibrosis in Asian subjects with chronic hepatitis B. PLoS One 2012;7:e35825PubMedCentralCrossRefPubMed Kim BK, Kim SU, Kim HS, Park JY, Ahn SH, Chon CY, et al. Prospective validation of FibroTest in comparison with liver stiffness for predicting liver fibrosis in Asian subjects with chronic hepatitis B. PLoS One 2012;7:e35825PubMedCentralCrossRefPubMed
26.
go back to reference Cardoso AC, Carvalho-Filho RJ, Stern C, Dipumpo A, Giuily N, Ripault MP, et al. Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C. Liver Int 2012;32:612–621CrossRefPubMed Cardoso AC, Carvalho-Filho RJ, Stern C, Dipumpo A, Giuily N, Ripault MP, et al. Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C. Liver Int 2012;32:612–621CrossRefPubMed
27.
go back to reference Lesmana CR, Salim S, Hasan I, Sulaiman AS, Gani RA, Pakasi LS, 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;64:916–920CrossRefPubMed Lesmana CR, Salim S, Hasan I, Sulaiman AS, Gani RA, Pakasi LS, 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;64:916–920CrossRefPubMed
28.
go back to reference Zhu X, Wang LC, Chen EQ, Chen XB, Chen LY, Liu L, 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;56:2742–2749CrossRefPubMed Zhu X, Wang LC, Chen EQ, Chen XB, Chen LY, Liu L, 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;56:2742–2749CrossRefPubMed
29.
go back to reference Cho HJ, Seo YS, Lee KG, Hyun JJ, An H, Keum B, et al. Serum aminotransferase levels instead of etiology affects the accuracy of transient elastography in chronic viral hepatitis patients. J Gastroenterol Hepatol 2011;26:492–500CrossRefPubMed Cho HJ, Seo YS, Lee KG, Hyun JJ, An H, Keum B, et al. Serum aminotransferase levels instead of etiology affects the accuracy of transient elastography in chronic viral hepatitis patients. J Gastroenterol Hepatol 2011;26:492–500CrossRefPubMed
30.
go back to reference Lee HJ, Seo YS, Kim DJ, Kang HS, An H, Kim JH, et al. Application of the HALF index obviates the need for liver biopsy in half of all patients with chronic hepatitis B. J Gastroenterol Hepatol 2011;26:987–995CrossRefPubMed Lee HJ, Seo YS, Kim DJ, Kang HS, An H, Kim JH, et al. Application of the HALF index obviates the need for liver biopsy in half of all patients with chronic hepatitis B. J Gastroenterol Hepatol 2011;26:987–995CrossRefPubMed
31.
go back to reference Myers RP, Elkashab M, Ma M, Crotty P, Pomier-Layrargues G. Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study. Can J Gastroenterol 2010;24:661–670PubMedCentralPubMed Myers RP, Elkashab M, Ma M, Crotty P, Pomier-Layrargues G. Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study. Can J Gastroenterol 2010;24:661–670PubMedCentralPubMed
32.
go back to reference Sporea I, Sirli R, Deleanu A, Tudora A, Popescu A, Curescu M, et al. Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study. World J Gastroenterol 2010;16:4832–4837PubMedCentralCrossRefPubMed Sporea I, Sirli R, Deleanu A, Tudora A, Popescu A, Curescu M, et al. Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study. World J Gastroenterol 2010;16:4832–4837PubMedCentralCrossRefPubMed
33.
go back to reference Gaia S, Carenzi S, Barilli AL, Bugianesi E, Smedile A, Brunello F, et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011;54:64–71CrossRefPubMed Gaia S, Carenzi S, Barilli AL, Bugianesi E, Smedile A, Brunello F, et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011;54:64–71CrossRefPubMed
34.
go back to reference Degos F, Perez P, Roche B, Mahmoudi A, Asselineau J, Voitot H, 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;53:1013–1021CrossRefPubMed Degos F, Perez P, Roche B, Mahmoudi A, Asselineau J, Voitot H, 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;53:1013–1021CrossRefPubMed
35.
go back to reference Bonnard P, Sombie R, Lescure FX, Bougouma A, Guiard-Schmid JB, Poynard T, 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;82:454–458PubMedCentralCrossRefPubMed Bonnard P, Sombie R, Lescure FX, Bougouma A, Guiard-Schmid JB, Poynard T, 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;82:454–458PubMedCentralCrossRefPubMed
36.
go back to reference Fung J, Lai CL, Chan SC, But D, Seto WK, Cheng C, et al. Correlation of liver stiffness and histological features in healthy persons and in patients with occult hepatitis B, chronic active hepatitis B, or hepatitis B cirrhosis. Am J Gastroenterol 2010;105:1116–1122CrossRefPubMed Fung J, Lai CL, Chan SC, But D, Seto WK, Cheng C, et al. Correlation of liver stiffness and histological features in healthy persons and in patients with occult hepatitis B, chronic active hepatitis B, or hepatitis B cirrhosis. Am J Gastroenterol 2010;105:1116–1122CrossRefPubMed
37.
go back to reference Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, 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;16:36–44CrossRefPubMed Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, 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;16:36–44CrossRefPubMed
38.
go back to reference Marcellin P, Ziol M, Bedossa P, Douvin C, Poupon R, de Ledinghen V, et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int 2009;29:242–247CrossRefPubMed Marcellin P, Ziol M, Bedossa P, Douvin C, Poupon R, de Ledinghen V, et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int 2009;29:242–247CrossRefPubMed
39.
go back to reference do Kim Y, Kim SU, Ahn SH, Park JY, Lee JM, Park YN, et al. Usefulness of FibroScan for detection of early compensated liver cirrhosis in chronic hepatitis B. Dig Dis Sci 2009;54:1758–1763CrossRefPubMed do Kim Y, Kim SU, Ahn SH, Park JY, Lee JM, Park YN, et al. Usefulness of FibroScan for detection of early compensated liver cirrhosis in chronic hepatitis B. Dig Dis Sci 2009;54:1758–1763CrossRefPubMed
40.
go back to reference Kim SU, Ahn SH, Park JY, Kang W, do Kim Y, Park YN, et al. Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis. J Clin Gastroenterol 2009;43:267–271CrossRefPubMed Kim SU, Ahn SH, Park JY, Kang W, do Kim Y, Park YN, et al. Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis. J Clin Gastroenterol 2009;43:267–271CrossRefPubMed
41.
go back to reference Wong GL, Chan HL, Choi PC, Chan AW, Yu Z, Lai JW, et al. Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther 2014;39:197–208CrossRefPubMed Wong GL, Chan HL, Choi PC, Chan AW, Yu Z, Lai JW, et al. Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther 2014;39:197–208CrossRefPubMed
43.
go back to reference Foucher J, Castera L, Bernard PH, Adhoute X, Laharie D, Bertet J, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol 2006;18:411–412CrossRefPubMed Foucher J, Castera L, Bernard PH, Adhoute X, Laharie D, Bertet J, et al. Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations. Eur J Gastroenterol Hepatol 2006;18:411–412CrossRefPubMed
44.
go back to reference Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894(i–xii):1–253 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894(i–xii):1–253
45.
go back to reference Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S. Criteria and classification of obesity in Japan and Asia-Oceania. World Rev Nutr Diet 2005;2005(94):1–12CrossRef Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S. Criteria and classification of obesity in Japan and Asia-Oceania. World Rev Nutr Diet 2005;2005(94):1–12CrossRef
Metadata
Title
Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: a systematic review and meta-analysis of a diagnostic test
Authors
Xueying Xu
Yang Su
Ruixiang Song
Yang Sheng
Wensi Ai
Xiaofei Wu
Hongbo Liu
Publication date
01-10-2015
Publisher
Springer India
Published in
Hepatology International / Issue 4/2015
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-015-9643-z

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