From the Guidelines
FibroScan interpretation should prioritize a cutoff of greater than 7.0 kPa to identify significant fibrosis (≥F2) and a cutoff of greater than 12.5 kPa to identify cirrhosis (F4), as recommended by the 2024 WHO guidelines 1.
Key Considerations for FibroScan Interpretation
- FibroScan measures liver stiffness in kilopascals (kPa) to assess fibrosis and uses the Controlled Attenuation Parameter (CAP) score in dB/m to assess steatosis.
- Readings below 7 kPa suggest minimal or no fibrosis, 7-10 kPa indicate moderate fibrosis, and values above 12-14 kPa suggest advanced fibrosis or cirrhosis.
- CAP scores below 238 dB/m typically indicate minimal steatosis, while scores above 290 dB/m suggest severe steatosis.
- Interpretation should consider the clinical context, including the underlying liver disease etiology, as cutoff values may vary slightly depending on the cause of liver disease.
Clinical Application and Limitations
- FibroScan results should be integrated with other clinical findings, laboratory tests, and patient history for a comprehensive liver health assessment.
- The test's reliability depends on proper technique and patient factors like obesity or ascites, which may affect accuracy.
- Recent guidelines, such as those from the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO), support the use of non-invasive tests like FibroScan for the assessment of liver fibrosis and cirrhosis 1.
Decision Making Based on FibroScan Results
- Patients with a FibroScan value greater than 7.0 kPa should be considered for further evaluation and potential treatment for significant fibrosis.
- Patients with a FibroScan value greater than 12.5 kPa should be considered for referral to a hepatologist for further evaluation and management of cirrhosis.
- The use of FibroScan and other non-invasive tests can help minimize the need for liver biopsy and improve patient outcomes by facilitating earlier diagnosis and treatment of liver disease 1.
From the Research
FibroScan Interpretation
FibroScan is a non-invasive medical device that measures liver stiffness to assess liver fibrosis. The interpretation of FibroScan results is crucial for the diagnosis and management of liver diseases.
Factors Affecting FibroScan Measurements
Several factors can affect FibroScan measurements, including:
- Liver inflammation: High levels of liver inflammation can lead to overestimation of liver fibrosis 2
- Probe selection: The choice of probe (M or XL) can significantly affect the results, and the correct probe should be selected based on the skin-liver capsule distance (SCD) or body mass index (BMI) 3
- Steatosis: While steatosis does not directly affect liver stiffness measurement (LSM), it can be assessed using the controlled attenuation parameter (CAP) 4, 5
- Congestion and cholestasis: These conditions can also affect LSM values 5
Diagnostic Accuracy of FibroScan
The diagnostic accuracy of FibroScan for assessing liver fibrosis and steatosis has been evaluated in several studies:
- The area under the receiver operating characteristic curve (AUROC) for significant fibrosis (≥ F2) was 0.93 6 and 0.863 2
- The optimal cutoff values for fibrosis stages were 7.5 kPa for ≥ F2 6, 7.3 kPa for ≥ F2 2, and 9.7 kPa for ≥ F3 2
- The AUROC for steatosis was 0.87 for S ≥ S1 4
Clinical Applications
FibroScan is a reliable method for the diagnosis of significant fibrosis and cirrhosis in patients with chronic liver disease 6. However, the results should be interpreted in the context of the patient's clinical and biological characteristics, and the limitations of the technique should be considered. A combination of FibroScan with other non-invasive factors can improve the accuracy of liver fibrosis assessment 2.