title: Factors That Could Impact on Liver Fibrosis Staging by Transient Elastography.
abstract: Transient elastography (TE) based on liver stiffness measurement (LSM) is one of the most validated noninvasive methods for liver fibrosis staging in patients with chronic liver diseases. This method is painless, has no potential complications, is rapid (<10 min), and can be performed at the patient's bedside. However, several points should be considered when interpreting TE results. This review aims to discuss the critical points that might influence liver stiffness and TE results. Spectrum bias and the impact of the prevalence of fibrosis stages should be taken into account when interpreting the studies that validated this method using liver biopsy as a gold-standard. LSM might be influenced by nonfasting status, flare of transaminases, heart failure, extrahepatic cholestasis, presence of steatosis, aetiology of liver disease, type and position of probe, and operator's experience. In addition, interobserver variability can impact on the management of patients with chronic liver diseases. TE should be performed by an experienced operator (>100 exams), in a 3-hour fasting status, and its results should be handled by specialist clinicians that are aware of the limitations of this method.
authors.affiliation: Evandro Chagas National Institute of Infectious Disease (INI), Oswaldo Cruz Foundation (FIOCRUZ), Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil.
authors.forename: Hugo
authors.initials: H
authors.lastname: Perazzo
authors.affiliation: Evandro Chagas National Institute of Infectious Disease (INI), Oswaldo Cruz Foundation (FIOCRUZ), Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil.
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Evandro Chagas National Institute of Infectious Disease (INI), Oswaldo Cruz Foundation (FIOCRUZ), Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Institute of Health Research, Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, St. Luke's Campus, South Cloisters, EX1 2LU Exeter, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Hyde
authors.affiliation: Evandro Chagas National Institute of Infectious Disease (INI), Oswaldo Cruz Foundation (FIOCRUZ), Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Castro