Feasibility and Diagnostic Performance of the Fibroscan XL... : Hepatology (original) (raw)

Liver Failure/Cirrhosis/Portal Hypertension

Feasibility and Diagnostic Performance of the Fibroscan XL Probe for Liver Stiffness Measurement in Overweight and Obese Patients

Myers, Robert P.1,*,†; Pomier–Layrargues, Gilles2; Kirsch, Richard3; Pollett, Aaron3; Duarte–Rojo, Andres4; Wong, David4; Beaton, Melanie5; Levstik, Mark5; Crotty, Pam1; Elkashab, Magdy6

1_Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada_

2_Liver Unit, Centre Hospitalier de l'Université de Montréal, Hôpital Saint–Luc, Montréal, Quebec, Canada_

3_Department of Pathology, Mt. Sinai Hospital, Toronto, Ontario, Canada_

4_Toronto Western Hospital Liver Centre, Toronto, Ontario, Canada_

5_Multi–Organ Transplant Unit, University of Western Ontario, London, Ontario, Canada_

6_The Toronto Liver Centre, Toronto, Ontario, Canada_

*Address reprint requests to: Liver Unit, University of Calgary, 6D22, Teaching, Research and Wellness Building, 3280 Hospital Drive N.W., Calgary, AB, Canada T2N 4Z6

Email: [email protected]

Received 19 April 2011; Accepted 16 August 2011

Dr. Myers is supported by a Clinical Investigator Award from the Alberta Heritage Foundation for Medical Research (now Alberta Innovates – Health Solutions) and New Investigator Award from the Canadian Institutes for Health Research. The study was sponsored by Echosens (Paris, France).

Potential conflict of interest: Dr. Myers consults for GE Healthcare. He is in the speakers' bureau of HNS Canada and received grants from Echosens. Dr. Pomier–Layrargues received grants from Echosens and Bristol–Myers Squibb.

†fax: 403–592–5090

Additional Supporting Information may be found in the online version of this article.

Abstract

Failure of liver stiffness measurement (LSM) by transient elastography (TE, FibroScan) and unreliable results occur in ≈5% and 15% of patients, respectively, mainly due to obesity. In this multicenter study, we evaluated the feasibility and performance of the novel FibroScan XL probe in 276 patients with chronic liver disease (42% viral hepatitis, 46% nonalcoholic fatty liver disease [NAFLD]) and a body mass index (BMI) ≥28 kg/m2. Patients underwent liver biopsy and TE with the standard M and XL probes. TE failure was defined as no valid LSMs and unreliable examinations as <10 valid LSMs or an interquartile range (IQR)/LSM >30% or success rate <60%. Probe performance for diagnosing ≥F2 fibrosis and cirrhosis (F4) versus biopsy were examined using areas under receiver operating characteristic curves (AUROC). FibroScan failure was less frequent with the XL probe than the M probe (1.1% versus 16%) and the XL probe was more often reliable (73% versus 50%; both P < 0.00005). Reliable results with the XL probe were obtained in 61% of patients in whom the M probe was unreliable. Among 178 patients with ≥10 valid LSMs using both probes, liver stiffness was highly correlated between probes (ρ = 0.86; P < 0.0005); however, median liver stiffness was lower using the XL probe (6.8 versus 7.8 kPa; P < 0.00005). The AUROC of the XL and M probes were similar for ≥F2 fibrosis (0.83 versus 0.86; P = 0.19) and cirrhosis (0.94 versus 0.91; P = 0.28). Conclusion : Compared with the M probe, the FibroScan XL probe reduces TE failure and facilitates reliable LSM in obese patients. Although the probes have comparable accuracy, lower liver stiffness cutoffs will be necessary when the XL probe is used to noninvasively assess liver fibrosis. (Hepatology 2012)