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. 2015 Nov 1;15(18):1–45.

Table 1:

Characteristics of Systematic Reviews

Author, Year Literature Search Objective Diagnostic Technology Population Conclusion AMSTAR Score
Bota et al, 2013 (35) Up to May 2012 To assess the diagnostic performance of 2 specific technologies compared to biopsy for the diagnosis of liver fibrosis

  • TE

  • ARFI

  • Biopsy

 Chronic hepatitis; excluded post-liver transplant ARFI has similar value to TE for significant fibrosis and cirrhosis 7
Chon et al, 2012 (36) 2002 to March 2011 To assess the diagnostic accuracy of TE to quantify liver fibrosis

  • TE

  • Biopsy

 Chronic HBV TE can be performed with good diagnostic accuracy in patients with chronic HBV 8
Friedrich-Rust et al, 2008 (37) 2002 to April 2007 To assess the diagnostic performance of TE for the diagnosis of liver fibrosis and patient factors that may impact the accuracy

  • TE

  • Biopsy

 All causes of liver disease TE is an excellent diagnostic tool for cirrhosis, but the underlying cause of liver disease impacts its accuracy for significant fibrosis 8
Friedrich-Rust et al, 2012 (38) Up to October 2010 To assess the diagnostic performance of ARFI for the diagnosis of liver fibrosis

  • TE

  • ARFI

  • Biopsy

 All causes of liver disease ARFI has good diagnostic accuracy for staging liver fibrosis 4
Kwok et al, 2014 (39) Up to June 2013 To assess the diagnostic performance of 3 specific technologies compared to biopsy for NASH and liver fibrosis

  • TE

  • ARFI

  • CK18

  • Biopsy

 NAFLD Noninvasive tests are good at excluding advanced cirrhosis and could be used as part of the initial assessment, but further evaluation of biomarkers are needed 8
Poynard et al, 2008 (32)a 1991 to 2008 To assess the diagnostic performance of any noninvasive technology for the assessment of liver fibrosis

  • TE

  • 14 different biomarkers (including FibroTest)

  • Biopsy

 All causes of liver disease There is no evidence to justify biopsy as a first-line estimate of liver fibrosis; biomarkers could be used as an alternative 3
Poynard et al, 2011 (31)a February 2001 to December 2010 To update the diagnostic accuracy evidence specific to hepatitis B from an earlier review (32)

  • TE

  • FibroTest

  • HepaScore

  • Enhanced liver fibrosis

  • Biopsy

 HBV TE and FibroTest were the most validated assessments of fibrosis in patients with HBV, but there were questions as to the reliability of FibroScan (TE brand name) 4
Shaheen et al, 2007 (40) January 1997 to October 2006 To assess the diagnostic performance of 2 specific technologies compared to biopsy for the diagnosis of liver fibrosis

  • TE

  • FibroTest

  • Biopsy

 HCV TE and FibroTest have excellent utility for diagnosing HCV-related cirrhosis, but are less accurate for earlier stages of fibrosis; these tests are not ready to fully replace biopsy in the diagnosis of disease 10
Shi et al, 2014 (41) Up to May 2013 To assess the diagnostic performance of the CAP add-on to TE to assess steatosis

  • CAP

  • Biopsy

 All causes of steatosis CAP has good sensitivity and specificity for diagnosing steatosis, but it has limited utility and should not be disseminated for widespread use 9
Steadman et al, 2013 (42, 43) 2001 to June 2011 To assess the diagnostic performance of TE and ARFI in adult liver disease, as well as TE in pediatric liver disease and other potential applications, such as use in examining breast tissue

  • TE

  • ARFI

  • Biopsy

 HCV, HBV, NAFLD, chronic liver disease, liver transplant patients TE is an accurate diagnostic method for moderate fibrosis or cirrhosis; more studies are necessary to establish the effectiveness in pediatric patients and other potential applications 10
Stebbing et al, 2010 (44) Not specified, but prior to February 2009 To assess the diagnostic performance of TE for the diagnosis of liver fibrosis

  • TE

  • Biopsy

 All causes of liver disease More research is needed to improve the sensitivity and establish the clinical utility of TE 6
Talwalkar et al, 2007 (45) Up to January 2007 To assess the diagnostic performance of TE for the diagnosis of liver fibrosis

  • TE

  • Biopsy

 All causes of liver disease TE is a clinically useful test for the diagnosis of cirrhosis 8
Tsochatzis et al, 2011 (46) Up to May 2009 To assess the diagnostic performance of TE for the diagnosis of liver fibrosis

  • TE

  • Biopsy

 All causes of liver disease TE has good sensitivity and specificity for cirrhosis—less so for lesser degrees of fibrosis; it should be cautiously applied to regular clinical practice due to a lack of validated cut-offs for stiffness values 9
Tsochatzis et al, 2015 (47, 48) 1998 to April 2012 To assess the diagnostic performance of noninvasive liver tests to diagnose liver fibrosis, and the incremental cost-effectiveness of the tests in managing disease

  • 53 unique noninvasive tests, including TE, ARFI, and FibroTest

  • Biopsy

 HCV, HBV, ALD, NAFLD The most cost-effective strategies were: for HCV, treating all patients without assessment; for HBV, treating all patients who were hepatitis B e antigen–negative without assessment, but there was uncertainty for hepatitis B e antigen–positive patients; for ALD, biopsy was cost-effective under certain assumptions; for NAFLD, it was not possible to determine the cost-effectiveness of fibrosis testing 9

Abbreviations: ALD, alcoholic liver disease; AMSTAR, Assessment of Multiple Systematic Reviews; ARFI, acoustic radiation force impulse; CAP, controlled attenuation parameter; CK-18, blood test of plasma cytokeratin-18 fragments; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; TE, transient elastography.

a

Poynard is the inventor of the FibroScan technology.