medwireNews: Offering liver stiffness measurement by vibration-controlled transient elastography (VCTE) at the time of routine retina scanning is generally acceptable among people with type 2 diabetes but may be subject to a high rate of false positivity, Swedish study findings indicate.
Hannes Hagström (Karolinska University Hospital, Stockholm) and co-investigators say that although guidelines recommend screening for advanced fibrosis due to metabolic dysfunction-associated steatotic liver disease (MASLD) in people with type 2 diabetes, it is unclear how best to implement such a strategy in clinical care.
They suggest that “one solution could be to integrate screening with existing health-care infrastructure.”
To investigate the potential of this, Hagström and team offered VCTE to 1301 people with type 2 diabetes referred for routine retina scanning in a large facility in Stockholm, Sweden, between 2020 and 2023.
They report in The Lancet Gastroenterology & Hepatology that 1005 (77.2%) participants agreed to undergo VCTE and 973 (74.8%) had complete measurements of controlled attenuation parameter (CAP) values.
The median CAP was 283 dB/m and 51.8% of participants with complete measurements had CAP values of 280 dB/m or higher, indicating MASLD.
Furthermore, 154 (15.8%) of 977 participants with reliable liver stiffness measurements had values of at least 8.0 kPa, suggestive of liver fibrosis, and 49 (5.0%) had values higher than 12.0 kPa, indicating possible advanced fibrosis. The median liver stiffness was 5.4 kPa.
Following VCTE, 165 participants with elevated or unreliable liver stiffness measurements were referred to the liver unit, 22 (13.3%) of whom rejected a second assessment.
Among those who were reassessed, 45.2% of 124 individuals who originally had results suggestive of liver fibrosis were found to have VCTE values below 8.0 kPa.
Hagström et al say that the “apparent overestimation at the initial visit could be caused by several factors,” including operator inexperience at the first visit, patients improving their general health between visits, low prevalence of advanced fibrosis, different fasting time periods, or the use of different probes on different VCTE machines.
They suggest that “methods to reduce overestimation require additional studies.”
After the second measurement, the prevalence of liver stiffness of at least 8.0 kPa was 7.4% in the full cohort of 1005 participants and the prevalence of values greater than 12.0 kPa was 2.9%.
Hagström and co-authors conclude that their “approach could be an attractive solution to people and health-care providers, centralising screening and not relying on increasing adherence to metabolic dysfunction-associated steatotic liver disease guidelines by individual primary care physicians, although not all countries and settings might have centralised retina scanning.”
However, they caution: “To mitigate the risk of false-positive results, two VCTE examinations should be considered before making decisions on clinical management.”
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Lancet Gastroenterol Hepatol 2024; doi:10.1016/S2468-1253(24)00313-3
