Area Under Curve Significance of FibroTest for Diagnosing Significant Liver Fibrosis
FibroTest demonstrates an area under the curve (AUC) of 0.86 for diagnosing significant liver fibrosis, indicating good diagnostic accuracy for this condition. 1
Diagnostic Performance of FibroTest
AUC Values for Different Fibrosis Stages
- FibroTest shows an AUC of 0.86 for significant fibrosis (≥F2), demonstrating good diagnostic capability 1
- For advanced fibrosis (≥F3), FibroTest demonstrates an AUC of 0.90, indicating excellent diagnostic performance 1
- For cirrhosis (F4), FibroTest shows an AUC of 0.89, also representing excellent diagnostic accuracy 1
Sensitivity and Specificity
- For significant fibrosis, FibroTest has a sensitivity of 61% and specificity of 79% at a cutoff value of 0.48 1, 2
- For advanced fibrosis, FibroTest demonstrates a sensitivity of 67% and specificity of 89% at a cutoff value of 0.58 1
- For cirrhosis, FibroTest shows a sensitivity of 62% and specificity of 91% at a cutoff value of 0.74 2
Comparison with Other Non-invasive Tests
Versus Other Serum Markers
- FibroTest outperforms non-patented serum markers like APRI and FIB-4 for diagnosing significant fibrosis in chronic liver disease 1, 3
- FibroTest incorporates substances directly related to extracellular matrix turnover and liver fibrosis, unlike indirect markers such as APRI and FIB-4 1, 3
Versus Elastography Methods
- FibroTest shows comparable performance to vibration-controlled transient elastography (VCTE) for diagnosing significant fibrosis and advanced fibrosis 1, 4
- In intention-to-diagnose analysis, FibroTest demonstrates no significant difference from VCTE in diagnostic performance 5
- When combined with elastography methods, FibroTest can further improve diagnostic accuracy and reduce the need for liver biopsy 6, 4
Performance in Different Liver Diseases
Chronic Hepatitis B
- In chronic hepatitis B, FibroTest shows an AUC of 0.86-0.90 for significant fibrosis 1, 4
- A meta-analysis of 16 studies including 2,494 patients with chronic hepatitis B found FibroTest had an AUC of 0.84 for significant fibrosis 2
Alcoholic Liver Disease
- In alcoholic liver disease, FibroTest demonstrates an AUC of 0.86 for significant fibrosis 1, 5
- For advanced fibrosis in alcoholic liver disease, FibroTest shows an AUC of 0.90, comparable to the Enhanced Liver Fibrosis test 5
Clinical Applications and Limitations
Clinical Utility
- FibroTest can be used to exclude advanced fibrosis in primary care settings with high negative predictive value (94%) 1
- Sequential use of FibroTest and elastography can improve diagnostic accuracy and reduce the need for liver biopsy by 20-28% 6, 4
Limitations
- FibroTest results can be affected by conditions that alter its component markers, such as hemolysis or acute inflammation 3
- Cutoff values vary across studies and may need adjustment based on the specific liver disease and population 1, 3
- Like other serum markers, FibroTest performs better for detecting cirrhosis than significant fibrosis 1, 2
Optimizing Diagnostic Accuracy
Combined Approaches
- Combining FibroTest with liver stiffness measurements can increase the AUC to 0.89-0.94 for significant fibrosis 6, 4
- A sequential algorithm using FibroTest followed by elastography in indeterminate cases can achieve >90% diagnostic accuracy while minimizing the need for liver biopsy 6
- In chronic hepatitis B patients, a combination formula multiplying liver stiffness by FibroTest (LS×FT) showed the best AUC of 0.941 for significant fibrosis 4