The performance of M and XL probes of FibroScan for the diagnosis of steatosis and fibrosis on a Brazilian nonalcoholic fatty liver disease cohort

Abstract

Objectives Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. Aim Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. Methods NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). Results Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64–0.84) and 0.76 (0.65–0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73–0.90) and 0.82 (0.71–0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71–0.93) and 0.80 (0.69–0.92) (P = 0.66). Conclusion Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.

Higher cut-off values of non-invasive methods might be needed to detect moderate-to-severe steatosis in morbid obese patients: a pilot study

“…We acknowledge that a recent study showed lower CAP values using M probe compared with XL probe in the detection of liver steatosis 29 . However, similar accuracy of both probes was observed in these studies despite differences in CAP cut-off values 30,31 . Moreover, despite extremely high BMI (median = 40.2 kg/m 2 ), the median distance between skin and liver capsule in the study population was 24.8 mm.…”

A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

“…After removing inappropriate studies, the inclusion criteria were fulfilled in 24 studies 14‐16,18,25‐43 (Figure 1). Nine articles used MRI‐PDFF, 14,16,18,25‐27,29,30 and 13 articles used TE‐CAP 31‐43 . Two studies compared the diagnostic performance of MR and TE methods for the noninvasive detection of liver fibrosis and steatosis in patients with NAFLD 15,17 .…”

Diagnostic Accuracy of FibroScan and Factors Affecting Measurements

“…Several studies have demonstrated the utility of the LSM for assessing liver fibrosis in patients with various chronic liver diseases including NAFLD. The studies on NAFLD patients are summarized in Table 1 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. The AUROCs for detecting fibrosis stages ≥1, ≥2, ≥3, and 4 have been reported as 0.78–0.97, 0.77–0.99, 0.73–1.00, and 0.89–0.997, respectively.…”

“…Like the LSM, the CAP is effective for diagnosing liver steatosis in patients with various chronic liver diseases [ 52 ]. The studies on patients with NAFLD are summarized in Table 2 [ 19 , 31 , 32 , 33 , 34 , 53 , 54 ]. The AUROCs for detecting steatosis scores of ≥1, ≥2, and 3 have been reported as 0.77–0.97, 0.638–0.92, and 0.67–0.83, respectively.…”