Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 953-960
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.953
Transient elastography improves detection of liver cirrhosis compared to routine screening tests
Thomas Göbel, Janine Schadewaldt-Tümmers, Lucas Greiner, Christopher Poremba, Dieter Häussinger, Andreas Erhardt
Thomas Göbel, Janine Schadewaldt-Tümmers, Dieter Häussinger, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany
Thomas Göbel, Lucas Greiner, Andreas Erhardt, Klinik für Gastroenterologie, Hepatologie und Diabetologie, Petrus-Krankenhaus Wuppertal, 42283 Wuppertal, Germany
Christopher Poremba, Pathologie München-Nord, Ernst-Platz-Straße 2, 80992 München, Germany
Author contributions: Göbel T, Schadewaldt-Tümmers J and Erhardt A wrote the manuscript; Erhardt A and Schadewaldt-Tümmers J analysed the data; Erhardt A and Schadewaldt-Tümmers J investigated the patients; Poremba C investigated liver biopsy samples; Greiner L and Häussinger D reviewed the paper; Erhardt A, Schadewaldt-Tümmers J and Häussinger D designed the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreas Erhardt, Professor, Klinik für Gastroenterologie, Hepatologie und Diabetologie, Petrus-Krankenhaus Wuppertal, Carnaper Str. 48, 42283 Wuppertal, Germany. andreas.erhardt@cellitinnen.de
Telephone: +49-202-2992861 Fax: +49-202-2992865
Received: June 7, 2014
Peer-review started: June 8, 2014
First decision: June 27, 2014
Revised: July 27, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Abstract

AIM: To investigate the diagnostic significance of transient elastography (TE) in a daily routine clinical setting in comparison to clinical signs, laboratory parameters and ultrasound.

METHODS: TE, ultrasound, laboratory parameters and cutaneous liver signs were assessed in 291 consecutive patients with chronic liver disease of various aetiologies who underwent liver biopsy in daily routine.

RESULTS: Sensitivity of TE for the detection of liver cirrhosis was 90.4%, compared to 80.1% for ultrasound, 58.0% for platelet count and 45.1% for cutaneous liver signs (P < 0.0001 for comparisons with histology). AUROC for TE was 0.760 (95%CI: 0.694-0.825). Combination of TE with ultrasound increased sensitivity to 96.1% and AUROC to 0.825 (95%CI: 0.768-0.882). TE correlated with laboratory parameters of cirrhosis progression like albumin (r = -0.43), prothrombin time (r = -0.44), and bilirubin (r = 0.34; P < 0.001 for each). Particularly, in patients with Child Pugh score A or normal platelet count TE improved sensitivity for the detection of liver cirrhosis compared to ultrasound by 14.1% (P < 0.04) and 16.3% (P < 0.02), respectively.

CONCLUSION: Transient elastography is superior to routine diagnostic tests allowing detection of liver cirrhosis in additional 10%-16% of patients with chronic liver disease that would have been missed by clinical examinations.

Keywords: Transient elastography, Fibroscan, Liver cirrhosis, Liver disease, Chronic hepatitis

Core tip: Diagnosis of liver cirrhosis is often missed in routine clinical practice. Novel non-invasive tools like transient elastography (TE) are available but their diagnostic performance for the detection of cirrhosis has only been poorly evaluated in a routine clinical setting, where screening and diagnosis is mainly based on clinical signs, simple laboratory parameters and conventional ultrasound. The present investigation shows that TE is found to be superior to routine diagnostic tests allowing detection of liver cirrhosis in an additional 10%-15% of patients. The highest diagnostic benefit is seen in patients with early cirrhosis or normal platelet count.