While liver biopsy is the current golden standard for the diagnosis and staging of fibrosis, many studies have highlighted the usefulness of non-invasive tests (NITs) for fibrosis screening and risk stratification. Despite this, pertinent NIT thresholds for these applications have yet to be defined.
The aim of this meta-analysis was to assess the performance of liver stiffness measurement by vibration controlled transient elastography (LSM-VCTE) compared to that of Fibrosis-4 Index (FIB-4) and NAFLD (non-alcoholic fatty liver disease) Fibrosis Score (NFS) as screening tests to exclude advanced fibrosis. It also aimed to determine effective NIT combinations to reduce liver biopsies in secondary care patients.
None of the studied NITs had both sufficiently high sensitivity and specificity (≥80%) when used with single cut-offs. Although LSM-VCTE performed better than FIB-4 and NFS in diagnosing advanced fibrosis, this performance was found to be influenced by biopsy quality, body mass index and presence of type 2 diabetes.
However, sequential combinations of NITs increase sensitivity and specificity, thus improving NITs’ diagnostic performance for both advanced fibrosis and cirrhosis. Sequentially combining FIB-4 and LSM-VCTE with lower cut-offs with specificity of 95% of 98% to rule out advanced fibrosis reduced the need for liver biopsies from 33% to 19%. Similarly, using this combination with upper cut-offs to diagnose cirrhosis lowered the need for liver biopsies from 33% to 24%. Applying these cut-offs in clinical practice may therefore reduce the need for liver biopsies in secondary care.