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Pournik, Alavian, and Eslami: Can We Accurately Assess Liver Fibrosis with Fibroscan® Using Fewer Valid Measurements?
Letter to the Editor
Gastroenterology & Hepatology
Yonsei Medical Journal

Yonsei Medical Journal 2013; 54(2): 541-542.

Published online: 22 January 2013

DOI: https://doi.org/10.3349/ymj.2013.54.2.541

Can We Accurately Assess Liver Fibrosis with Fibroscan® Using Fewer Valid Measurements?

Omid Pournik1, Seyed Moayed Alavian2, Saeid Eslami1, 3, 4

1Medical Informatics Research Center, Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2Middle East Liver Disease Center, Tehran, Iran.

3Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

4Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Corresponding author: Dr. Seyed Moayed Alavian, Middle East Liver Disease Center, No. 178, Shadab crossroad, Sepahbod Gharani St. Tehran, Iran. Tel: 9821-88945186, Fax: 9821-88945188, alavian@thc.ir

Received 5 December 2012       Accepted 6 December 2012

© Copyright: Yonsei University College of Medicine 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We read with great interest the article of Jang, et al.1 in March 2012 of Yonsei Medical Journal. The authors challenged the manufacturers' recommendation for 10 measurements for liver evaluation using FibroScan® (Fibroscan device 502-EchoSens, Paris, France). They were seeking the minimum number of measurements which is needed for liver evaluation using FibroScan®. The authors concluded that 3 valid measurements (VMs) would provide the same result as 10 VMs. In our experience in Middle East Liver Disease Center, we agree that in many cases same results might be achieved with fewer numbers of VMs.
There is an important concern in reducing the number of measurements in clinic. At present, the detection of reliable evaluations is made based on a success rate of at least 60% and an interquartile range/median value less than 0.3 as reliable.2 Although some researchers believe the above mentioned factors are not predictive of the accuracy,3,4 no other criterion is available. The interquartile range can eliminate the effect of outlier and extreme measures, but with only 3 measurements, the results will be affected by such measurements.
Many health conditions can adversely affect the accuracy of Fibroscan®. Steatosis, metabolic syndrome, high body mass index (BMI), hepatic haemangioma and heart failure are examples of such cases.5 In these subgroup of patients, accuracy of using 3 measurements could be different and lack of subgroup analysis could affect generalizability of the results. The average BMI of the participants in this study was in normal range which does not provide much evidence about the diagnostic accuracy of 3 VMs in patients with high BMI.
If the number of measurements is to be reduced, new criteria for detection of reliable evaluations should be studied and introduced, especially when there are chances of steatosis, metabolic syndrome or high BMI.

Notes

The authors have no financial conflicts of interest.

References

1. Jang HW, Kim SU, Park JY, Ahn SH, Han KH, Chon CY, et al. How many valid measurements are necessary to assess liver fibrosis using FibroScan® in patients with chronic viral hepatitis? An analysis of subjects with at least 10 valid measurements. Yonsei Med J. 2012. 53:337–345.
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2. Lucidarme D, Foucher J, Le Bail B, Vergniol J, Castera L, Duburque C, et al. Factors of accuracy of transient elastography (fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C. Hepatology. 2009. 49:1083–1089.
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3. Myers RP, Crotty P, Pomier-Layrargues G, Ma M, Urbanski SJ, Elkashab M. Prevalence, risk factors and causes of discordance in fibrosis staging by transient elastography and liver biopsy. Liver Int. 2010. 30:1471–1480.
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4. Kim SU, Seo YS, Cheong JY, Kim MY, Kim JK, Um SH, et al. Factors that affect the diagnostic accuracy of liver fibrosis measurement by Fibroscan in patients with chronic hepatitis B. Aliment Pharmacol Ther. 2010. 32:498–505.
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5. Aalaei-Andabili SH, Mehrnoush L, Salimi S, Shafiei M, Alavian SM. Liver Hemangioma Might Lead to overestimation of Liver Fibrosis by Fibroscan; A Missed Issue in Two Cases. Hepat Mon. 2012. 12:408–410.
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