The performance of transient elastography compared to clinical acumen and routine tests - what is the incremental diagnostic value?

• Published in: Liver international 2013-02, Vol.33 (2), p.172-179
• Main Authors: Dolman, Grace E., Nieboer, Daan, Steyerberg, Ewout W., Harris, Scott, Ferguson, Amanda, Zaitoun, Abed M., Ryder, Stephen D., James, Martin W., Aithal, Guruprasad P., Guha, Indra Neil
• Format: Article
• Language: English
• Subjects: Area Under Curve; biomarkers; cirrhosis; Clinical Competence; Diagnosis, Differential; diagnostic tests; Diagnostic Tests, Routine - methods; Elasticity Imaging Techniques - methods; fibrosis; Humans; liver; Liver Cirrhosis - diagnosis; Retrospective Studies
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.12017

Background/Aims There is substantial evidence suggesting transient elastography (TE) is a useful tool in assessing liver fibrosis. We aimed to determine whether TE has incremental diagnostic value over clinical acumen and routinely available tests. Methods We performed a retrospective study of 130 patients to assess the ability of hepatologists to predict severity of fibrosis using clinical acumen; clinical acumen with routine tests; and elastography in patients with chronic liver disease. The incremental diagnostic benefit was assessed using the area under the ROC curve (AUC) and the Net Reclassification Index (NRI). Results Using universally available tests, including clinical acumen, the AUCs for detection of cirrhosis ranged from 0.70 to 0.80 for the four hepatologists. Elastography led to statistically non‐significant improvements in AUC statistics (range 0.83–0.89; P > 0.01). The detection of significant fibrosis using clinical acumen and routine tests was less accurate, with AUCs of 0.52–0.59. Elastography had incremental diagnostic value (AUC performance range 0.76–0.82; P