Fobroscan accuracy

[chanthou]

My doctor probed my liver stiffness by putting the probe at one location and hit 10 times.

By hitting the probe at the same spot, would the result obtained represent the stiffness of the whole liver?

[stef2011]

http://onlinelibrary.wiley.com/doi/10.1111/j.1872-034X.2010.00687.x/abstract

12months entecavir and fibrosis redction, median liver stiffness significantly decreased from 11.2 kPa (7.0–15.2) to 7.8 kPa (5.1–11.9; P = 0.0090) during 12 months.
mine got from 16.3kpa to about 9kpa in 10 and a hlf months

[stef2011]

all very important articles to understand fibroscan and severity of liver damage

http://archive.mail-list.com/hbv_research/message/20081117.085216.57722c4a.en.html

http://archive.mail-list.com/hbv_research/message/20080812.070239.b6a938a6.en.html

http://archive.mail-list.com/hbv_research/message/20090727.081115.82d23004.en.html

http://archive.mail-list.com/hbv_research/message/20100805.173823.fb7b7b03.en.html

[stef2011]

another thing about fibroscan i forgot, fibroscan has been used routinely in europe since 2004 so the values have been studied on caucasians very deeply.
fbroscans are still missing in US/canada but for caucaisnas values are the same but this is not the same for asians.fibroscans have been started in asia too recently but the values are different on asians and probably on black people too.

so the values have maximum accuracy for caucasians while for asians and black people we might have to wait for maximum accuracy

[stef2011]

if her choice is interferon the effect on fibrosis is little and at first it might even increase fibrosis because interferon makes alt flares.
the reduction of fibrosis by interferon is when it makes hbvdna und and hbsag low but this is achieved only in a small percentage while entecavir makes hbvdna und in 90% cases and more by the time.
like in my case use of entecavir first will regress liver damage and addition of combo interferon or nitazoxanide will reduce virus in a second moment after about 48weeks

fibroscan is the most accurate on such high quantity of fibrosis or cirrhosis.the risk to be on cirrhosis is very close to 100% when the value is higher than 12.5kpa, but again as i said earlier it makes no difference if cirrhosis or f3, the fibrosis is in both cases too high and must be reduced by treatment as soon as possible

fibroscan can be wrong only in the case she had high alt flares like acute hbv, alt 1000 or higher, in this case the liver is inflammed for at least 6 months after alt get back to normal, so if she knows she didn t have alt at 1000 or higher in the last 6 months the reading is correct.
usually fibroscan is remade at 3motnhs intervals just to see if the reading is fibrosis or inflammation

[stef2011]

The average value is 11.4 Kpa.
this is very bad value, the cirrhosis risk startes from 11.5kpa so she is already in the range of early cirrhosis, she must start treatment immediately and interferon alone is not good to regress fibrosis, she might do like me entecavir and then add interferon after about 1year when she sees the cirrhosis/severe fibrosis has regressed

she is also at increased risk of liver cancer, the increase starts from 10kpa, i'd not make a biopsy absolutely because it is not important to know if she is cirrhosis or f3 fibrosis, it makes no difference to know, they are both advanced liver damage, and also biopsy makes a little damage to the liver which is relevant when fibrosis is so much

of course she needs to monitor by fibroscan until fibrosis regresses to less than 8-7kpa and then add interferon

[chanthou]

The average value is 11.4 Kpa.  It is from 10 hittings at the same spot. ALT is 24 UI/ml.  8 months before, previous doctor made 10 hittings on different spot. It was 10.2 Kpa

So you mean for those who are on f3-f4, you don't need to hit in many spots?

F3-F4 is fibrosis or cirrhosis?

[stef2011]

By hitting the probe at the same spot, would the result obtained represent the stiffness of the whole liver?
no the whole but it is the more accurate tool especially for f3-f4 cirrhosis damage, much less for f0-f1 which is zero damage

biopsy is much less accurate, only good to confirm f0 fibrosis

what is the value?

accuracy of fibroscan is affected by bmi or alt flares higher than 200 before or during fibroscan reading, making more readings every 6 months is the best tool to monitor liver damage or improvment during therapy