Introduction Transient elastography (Fibroscan) is a simple, non-invasive method of assessing liver fibrosis. It is measured by an ultrasound transducer probe and results are expressed in kilo-Pascals (kPa) with liver stiffness values ranging from 2.5 to 75 kPa. The results are immediately available and are operator-independent. Liver biopsy has long been the gold standard to evaluate fibrosis. Unfortunately, it is invasive and associated with complications. In addition the accuracy of the histology sample is subject to significant heterogeneity. Our aim was to determine how effective Fibroscan is in reducing the need for liver biopsy.
Methods All patients undergoing Fibroscan during a 1-year period from 1 August 2010 to 31 July 2011 in the Royal Victoria Hospital, Belfast were included. Patients who had biopsy pre-planned for the same day as Fibroscan were excluded. The following data were recorded: demographic data, Fibroscan readings, indication for Fibroscan and whether or not Fibroscan prevented the need for subsequent liver biopsy. All patients had at least 10 valid readings.
Results 66 patients (36 male) underwent Fibroscan to evaluate if there was any evidence of advanced fibrosis or cirrhosis. The underlying liver diagnoses were Hepatitis C (30), fatty liver disease (7), primary biliary cirrhosis (7), hepatitis B (6), hereditary haemochromatosis (4), deranged liver function tests (4), alcoholic liver disease (3), orthotopic liver transplant (2) and 1 each for cryptogenic cirrhosis, primary sclerosing cholangitis and hyperferritinaemia. Thirty-nine patients had a normal Fibroscan of whom 37 (95%) did not require a follow-up liver biopsy. 27 patients had high readings suggesting advanced liver fibrosis or cirrhosis of whom 8 (30%) required liver biopsy. Of the remainder, 16 (59%) did not require biopsy because Fibroscan had answered the clinical question and three failed to attend for review. Overall, 53 (80%) did not require a liver biopsy after Fibroscan was used to determine the presence or absence of advanced fibrosis or cirrhosis.
Conclusion In our cohort, Fibroscan prevented the need for liver biopsy in 80% of patients. Our main use of the test has been in attempting to identify patients with cirrhosis who might need hepatoma screening. Fibroscan is highly effective in reducing the need for biopsy in such cohorts.
Competing interests None declared.
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