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Systematic review with meta‐analysis: the diagnostic accuracy of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B
Author(s) -
Li Y.,
Huang Y.S.,
Wang Z.Z.,
Yang Z.R.,
Sun F.,
Zhan S.Y.,
Liu X.E.,
Zhuang H.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13488
Subject(s) - transient elastography , medicine , receiver operating characteristic , liver biopsy , meta analysis , elastography , fibrosis , stage (stratigraphy) , chronic hepatitis , liver fibrosis , radiology , biopsy , gastroenterology , ultrasound , virus , immunology , paleontology , biology
Summary Background Transient elastography is a non‐invasive method for staging liver fibrosis. The meta‐analysis using the hierarchical models to evaluate the diagnostic accuracy of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B was rarely reported. Aim A meta‐analysis using the hierarchical models was performed to assess transient elastography for diagnosing and stage liver fibrosis in patients with chronic hepatitis B. Methods Electronic databases were searched and studies were identified to assess the diagnostic accuracy of transient elastography in CHB patients for staging fibrosis F ≥ 2, F ≥ 3 and F = 4 with liver biopsy as a reference standard. The hierarchical summary receiver operating characteristic curve and the bivariate models were performed to evaluate the diagnostic accuracy of transient elastography, and meta‐regression analyses were performed to explore the heterogeneity. The quality Assessment of Diagnostic Accuracy Studies‐2 tool was used to assess the quality of studies. Results Twenty‐seven studies with a total of 4386 patients were included in the meta‐analysis. The summary sensitivity of transient elastography for staging fibrosis F ≥ 2, F ≥ 3 and F = 4 was 0.806 (95% CI, 0.756–0.847), 0.819 (95% CI, 0.748–0.874) and 0.863 (95% CI, 0.818–0.898), respectively, and the summary specificity was 0.824 (95% CI, 0.761–0.873), 0.866 (95% CI, 0.824–0.899) and 0.875 (95% CI, 0.840–0.903), respectively. The corresponding area under the summary receiver operating characteristic curve was 0.88 (95% CI, 0.85–0.91), 0.91 (95% CI, 0.88–0.93) and 0.93 (95% CI, 0.91–0.95), respectively. Meta‐regression showed that patient age contributed to heterogeneity. Conclusions Transient elastography performs well to diagnose liver fibrosis in patients with chronic hepatitis B, which may reduce the use of liver biopsy.