Biological tests, elastographic methods alone or in combination can be used for the non-invasive evaluation of chronic liver diseases, in order to increase their value.
The combination of TE and serological tests offered a good diagnostic performance, both for significant fibrosis (F≥2) and for severe fibrosis/cirrhosis (F3–F4) diagnosis. A clinical management algorithm, using the combination of FibroScan and FibroTest as part of the first-line work-up was developed for liver fibrosis assessment in HCV patients. By using this algorithm, liver biopsy would have been avoided in the majority (77%) of patients. In HBV inactive carriers, the combination of TE and FibroTest allowed the exclusion of significant fibrosis (F≥2) in nearly 80% of cases.
Another useful combination is the one between two elastographic methods (TE and ARFI), being highly specific for predicting significant fibrosis (F≥2 Metavir). For predicting F≥2, when LS by means of both TE and ARFI were higher than the proposed cut-offs, the sensitivity was 93.3%, the positive predictive value was 96.8%, so that in those patients, liver biopsy could be avoided (60.5% of cases). For predicting cirrhosis (F4) the results were also very good, with 94.4% specificity, 94.4% negative predictive value and 91.8% accuracy, so the combined methods are not only able to confirm, but also to exclude the presence of cirrhosis.
Keywords: Serological tests, elastography, liver fibrosis, combination methods.