FibroTest and FibroScan for the Prediction of Hepatitis C-Related Fibrosis: A Systematic Review of Diagnostic Test Accuracy

• Published in: The American journal of gastroenterology Vol. 102; no. 11; pp. 2589 - 2600
• Main Authors: SHAHEEN, Abdel Aziz M, WAN, Alex F, MYERS, Robert P
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.11.2007; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Area Under Curve; Biological and medical sciences; Biomarkers - analysis; Biopsy; Digestive system; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis C virus; Hepatitis C, Chronic - complications; Human viral diseases; Humans; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Predictive Value of Tests; Sensitivity and Specificity; Viral diseases; Viral hepatitis; Performance evaluation; Prevalence; Hepatic disease; Review; Epidemiology; Viral hepatitis A; Accuracy; Transient elastography; Diagnosis; Viral hepatitis C; Human; Liver biopsy; Infection; Virus; Cirrhosis; Treatment; Viral disease; Fibrosis; Digestive diseases; Medical imagery; Flaviviridae; Predictive factor; Hepatitis C virus; Hepacivirus; Bibliographic review
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2007.01466.x

The accurate diagnosis of hepatitis C virus (HCV)-related fibrosis is crucial for prognostication and treatment decisions. Due to the limitations of biopsy, noninvasive alternatives including FibroTest and FibroScan have been developed. Our objective was to systematically review studies describing the accuracy of these tests for predicting HCV-related fibrosis. Studies comparing FibroTest or FibroScan versus biopsy in HCV patients were identified via an electronic search. Random effects meta-analyses and areas under summary receiver operating characteristics curves (AUC) were examined to characterize test accuracy for significant fibrosis (F2-4) and cirrhosis. Heterogeneity was explored using meta-regression. Twelve studies were identified, 9 for FibroTest (N = 1,679) and 4 for FibroScan (N = 546). In heterogeneous analyses for significant fibrosis, the AUCs for FibroTest and FibroScan were 0.81 (95% CI 0.78-84) and 0.83 (0.03-1.00), respectively. At a threshold of approximately 0.60, the sensitivity and specificity of the FibroTest were 47% (35-59%) and 90% (87-92%). For FibroScan (threshold approximately 8 kPa), corresponding values were 64% (50-76%) and 87% (80-91%), respectively. Methodological quality, the length of liver biopsy specimens, and inclusion of special populations did not explain the observed heterogeneity. However, the diagnostic accuracy of both measures was associated with the prevalence of significant fibrosis and cirrhosis in the study populations. For cirrhosis, the summary AUCs for FibroTest and FibroScan were 0.90 (95% CI not calculable) and 0.95 (0.87-0.99), respectively. FibroTest and FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.