https://www.journal-of-hepatology.eu/article/S0168-8278(15)00259-7/pdf

EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis.

The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way.

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EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography.Part 2: Clinical Applications

We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.

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EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of elastography used in breast imaging. The literature on various breast elastography techniques is reviewed, and recommendations are made on evidence-based results. Practical advice is given on how to perform and interpret breast elastography for optimal results, with emphasis placed on avoiding pitfalls. Artifacts are reviewed, and the clinical utility of some artifacts is discussed. Both strain and shear wave techniques have been shown to be highly accurate in characterizing breast lesions as benign or malignant. The relationship between the various techniques is discussed, and recommended interpretation based on a BI-RADS-like malignancy probability scale is provided. This document is intended to be used as a reference and to guide clinical users in a practical way.

WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 2: Breast

https://research.birmingham.ac.uk/portal/files/58693069/Eddowes_et_al_Accuracy_of_fibroscan_controlled_Gastroenterology_2019.pdf

Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy

Introduction Transient elastography is a non-invasive method developed as an alternative to liver biopsy to assess fibrosis severity. In this meta-analysis, we assessed the performance of elastography in diagnosing fibrosis using liver biopsy as the reference standard. Methods Electronic search of MEDLINE, EMBASE, Science citation index and Cochrane Library; and hand-search of major conference abstracts and article references were performed by two authors independently. Included studies used biopsy as reference standard, reported on data necessary to calculate the true-positive, false-positive, true-negative, and false-negative diagnostic results of elastography for a fibrosis stage and had a 3-month maximum interval between tests. METAVIR F2 and cirrhosis were analysed. Study quality was assessed using the QUADAS tool. Data were combined using the hierarchical summary receiver operator characteristics, and bivariate normal random-effects analysis of sensitivity and specificity methods, using the METANDI module. Results We identified 40 eligible studies (32 full papers). No article was assessed as adequate for all the questions in QUADAS. Only nine studies had both an acceptable reference and index test quality. Overall, the summary sensitivity and specificity was 0.79 (95% CI 0.74 to 0.82) and 0.78 (95% CI 0.72 to 0.83) for F2 and 0.83 (95% CI 0.79 to 0.86) and 0.89 (95% CI 0.87 to 0.91) for cirrhosis. With an elastography result at or over the threshold value as determined in each study, for F2 or cirrhosis (“positive” result), the corresponding post-test probability for presence of these stages (if pre-test probability was 50%) was 78%, and 88%, respectively, while values falling below those thresholds (“negative” result), the post-test probability was 21% and 16%, respectively. No optimal stiffness cut-offs for specific fibrosis stages were validated in independent cohorts. There was a wide range and overlap of cut-offs within and between different fibrosis stages. Conclusion Elastography is a good screening test for cirrhosis, with an 88% disease probability following a “positive” measurement, and a slightly worse tool in F=2. However, a “negative” measurement is less accurate, with disease being present in 15–20% of cases depending on fibrosis stage. Validation of liver stiffness cut-offs is required before elastography can be considered as sufficiently accurate for non-invasive diagnosis of fibrosis stages.

https://gut.bmj.com/content/gutjnl/59/Suppl_1/A15.1.full.pdf

S. Ntaoula

Papers

Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy

OC-035 Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a diagnostic test accuracy meta-analysis