title: Development and evaluation of a nurse-led transient elastography service for the staging of hepatic fibrosis in patients with suspected chronic liver disease.
abstract: OBJECTIVE
  Establishing the presence of fibrosis and cirrhosis is an essential step in the management of patients with chronic liver diseases (CLD). Liver stiffness measurement (LSM) based on transient elastography (TE) correlates well with the stages of liver fibrosis and has been developed as a non-invasive alternative to liver biopsy. The studies performed to date have used physician operators. With the potential use of TE for screening of community-based populations for liver disease, we aimed to evaluate the performance of nurse operators.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  We reviewed the reliability and accuracy of LSMs performed by the nurse-led TE service at Queen's Medical Centre, Nottingham between May 2009 and January 2011. Consecutive patients with suspected CLD who underwent LSM were included.
  
  
  RESULTS
  Over the study period 585 LSMs were performed. Analysis was performed on the 208 patients where LSM could be compared with liver biopsy findings. Of these 11 (5.3%) had unreliable LSM results (less than 10 valid shots or success rate <60%). There were no LSM failures. Inadequate liver biopsy specimen led to exclusion in 26 (12.5%) patients. For the detection of significant fibrosis (Ishak stage >2), a sensitivity of 0.78 and specificity of 0.81 was obtained, with a cut-off value of 8 kPa. Using a cut-off value of 13 kPa for detection of cirrhosis, a sensitivity and specificity of 0.8 and 0.92 was obtained.
  
  
  CONCLUSIONS
  We have demonstrated that a nurse-led TE service can produce a low level of unreliable results and LSM failures, with comparable sensitivity and specificity for detecting significant fibrosis and cirrhosis to those reported in the literature. The demands on the use of TE could potentially be eased through the introduction of nurse-led service delivery.
authors.affiliation: Department of Hepatology, National Institute of Health Research: Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, UK. rogermccorry@hotmail.com
authors.forename: R B
authors.initials: RB
authors.lastname: McCorry
authors.forename: N
authors.initials: N
authors.lastname: Palaniyappan
authors.forename: A
authors.initials: A
authors.lastname: Chivinge
authors.forename: P
authors.initials: P
authors.lastname: Kaye
authors.forename: M W
authors.initials: MW
authors.lastname: James
authors.forename: G P
authors.initials: GP
authors.lastname: Aithal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002908:Chronic Disease; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000451:nursing*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000451:nursing* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult