title: A meta-analysis of transient elastography for the detection of hepatic fibrosis.
abstract: OBJECTIVE
  The use of transient elastography to assess liver stiffness measurement (LSM) has now become widely available for the diagnosis of liver fibrosis as a rapid, noninvasive test (it is still not approved for use in the United States). It has previously been showed as an accurate method of representing the state of liver fibrosis with concomitant evaluation of liver biopsy and the histologic scoring system METAVIR. We performed a meta-analysis to further assess its use in comparison with liver biopsy.
  
  
  METHODS
  Studies from the literature were analyzed with a median liver stiffness value in kilopascal given for fibrosis stages according to histopathologic findings on biopsy and best discriminant cutoff levels in kilopascals for significant fibrosis (>or=F2) and cirrhosis (F4).
  
  
  RESULTS
  A total of 22 studies were selected comprising 4,430 patients; chronic hepatitis C infection was the most common etiology of fibrosis. The pooled estimates for significant fibrosis (>or=F2) measured 7.71 kPa (LSM cutoff value) with a sensitivity of 71.9% [95% confidence interval (CI): 71.4%-72.4%] and specificity of 82.4% (95% CI: 81.9-82.9%), whereas for cirrhosis (F4) the results showed a cutoff of 15.08 kPa with a sensitivity of 84.45% (95% CI: 84.2-84.7%) and specificity of 94.69% (95% CI: 94.3%-95%).
  
  
  CONCLUSIONS
  Further evaluation of transient elastography to assess LSM is required in prospective studies to potentially increase the sensitivity and establish its clinical utility.
authors.affiliation: Department of HIV Medicine, Chelsea and Westminster Hospital, St Stephen's Centre, Imperial College School of Medicine, London, UK. j.stebbing@imperial.ac.uk
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Lavanta
authors.initials: L
authors.lastname: Farouk
authors.forename: George
authors.initials: G
authors.lastname: Panos
authors.forename: Mike
authors.initials: M
authors.lastname: Anderson
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods; D016208:Databases, Factual; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity