Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

2009 Hepatology International 3, 2 (323-333)

Several studies evaluated the accuracy of FibroScan, blood tests, or combinations compared with liver biopsy. Most include patients with HCV infection, one includes patients with chronic liver disease of any origin, one includes patients with biliary cirrhosis due to primary biliary cirrhosis or primary sclerosing cholangitis, and one includes only those patients who are coinfected with HIV and HCV. These studies show that FibroScan results are reproducible across operators and time. All the studies report that FibroScans diagnostic performance is good, indicating that it agrees perfectly with liver biopsy.
Two recent meta-analyses assessed the utility of FibroScan in evaluating liver fibrosis. They showed that for patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity were 87%, specificity 91%, positive likelihood ratio 11.7, and negative likelihood ratio 0.14. Their analysis concluded that transient elastography is a clinically useful test for detecting cirrhosis. Shaheen et al. analyzed studies published for both FibroScan and FibroTest for detecting cirrhosis, the summary area under the curves for FibroScan was 0.95 (0.87-0.99) and for FibroTest was 0.90. Both had less sensitivity for differentiating minor degrees of fibrosis.
Consensus statements
- Clinical utility of FibroScan techniques would be proven by further studies in large number of patients (2b, B).

This is a new serum model that is claimed to outperform other models. The six parameters required to calculate FibroMeter are platelets, PT index, AST, a-2-M, HA, and urea levels.
Consensus statements
- Noninvasive tests are useful for identifying only those patients with no fibrosis or with extreme levels of fibrosis (1a, A).
- Staging of liver fibrosis in the intermediate range cannot be satisfactorily predicted by any of the available tests (1a, A).
- A stepwise algorithm incorporating noninvasive markers of fibrosis may reduce the number of liver biopsies by about 30% (1a, A).