Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice

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Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice. / Armstrong, Matthew; Corbett, Christopher; Hodson, J.; Marwah, N.; Parker, R.; Houlihan, D. D.; Rowe, I. A.; Hazlehurst, J. M.; Brown, R.; Hubscher, S. G.; Mutimer, D.

In: Postgraduate Medical Journal, Vol. 89, No. 1058, 01.12.2013, p. 685-692.

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@article{0d1c5e633de541fdab0f268adc2fbf07,
title = "Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice",
abstract = "Background Fibroscan is a quick, non-invasive technique used to measure liver stiffness (kPa), which correlates with fibrosis. To achieve a valid liver stiffness evaluation (LSE) the operator must obtain all the following three criteria: (1) ≥10 successful liver stiffness measurements; (2) IQR/median ratio <0.30 and (3) ≥60% measurement success rate.Objectives To assess the operator training requirements and the importance of adhering to the LSE validity criteria in routine clinical practice.Methods We retrospectively analysed the LSE validity rates of 2311 Fibroscans performed (1 August 2008 to 31 July 2011) in our tertiary liver outpatients department at the University Hospital Birmingham, UK. The diagnostic accuracy of Fibroscan was assessed in 153 patients, by comparing LSE (valid and invalid) with the modified Ishak fibrosis stage on liver biopsy.Results Learning curve analysis highlighted that the greatest improvement in validity of LSE rates occurs in the operator{\textquoteright}s first 10 Fibroscans, reaching 64.7% validity by the 50th Fibroscan. The correlation between LSE and the fibrosis stage on liver biopsy was superior in patients with a valid LSE (n=97) compared with those with an invalid LSE (n=56) (rs 0.577 vs 0.259; p=0.022). Area under receiving operating characteristics for significant fibrosis was greater when LSE was valid (0.83 vs 0.66; p=0.048). Using an LSE cut-off of 8 kPa, the negative predictive value of valid LSE was superior to invalid LSE for the detection of significant (84% vs 71%) and advanced fibrosis (100% vs 93%).Conclusions Fibroscan requires minimal operator training (≥10 observed on patients), and when a valid LSE is obtained, it is an accurate tool for excluding advanced liver fibrosis. To ensure the diagnostic accuracy of Fibroscan it is essential that the recommended LSE validity criteria are adhered to in routine clinical practice.",
author = "Matthew Armstrong and Christopher Corbett and J. Hodson and N. Marwah and R. Parker and Houlihan, {D. D.} and Rowe, {I. A.} and Hazlehurst, {J. M.} and R. Brown and Hubscher, {S. G.} and D. Mutimer",
year = "2013",
month = dec,
day = "1",
doi = "10.1136/postgradmedj-2012-131640",
language = "English",
volume = "89",
pages = "685--692",
journal = "Postgraduate Medical Journal",
issn = "0032-5473",
publisher = "BMJ Publishing Group",
number = "1058",

}

RIS

TY - JOUR

T1 - Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice

AU - Armstrong, Matthew

AU - Corbett, Christopher

AU - Hodson, J.

AU - Marwah, N.

AU - Parker, R.

AU - Houlihan, D. D.

AU - Rowe, I. A.

AU - Hazlehurst, J. M.

AU - Brown, R.

AU - Hubscher, S. G.

AU - Mutimer, D.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background Fibroscan is a quick, non-invasive technique used to measure liver stiffness (kPa), which correlates with fibrosis. To achieve a valid liver stiffness evaluation (LSE) the operator must obtain all the following three criteria: (1) ≥10 successful liver stiffness measurements; (2) IQR/median ratio <0.30 and (3) ≥60% measurement success rate.Objectives To assess the operator training requirements and the importance of adhering to the LSE validity criteria in routine clinical practice.Methods We retrospectively analysed the LSE validity rates of 2311 Fibroscans performed (1 August 2008 to 31 July 2011) in our tertiary liver outpatients department at the University Hospital Birmingham, UK. The diagnostic accuracy of Fibroscan was assessed in 153 patients, by comparing LSE (valid and invalid) with the modified Ishak fibrosis stage on liver biopsy.Results Learning curve analysis highlighted that the greatest improvement in validity of LSE rates occurs in the operator’s first 10 Fibroscans, reaching 64.7% validity by the 50th Fibroscan. The correlation between LSE and the fibrosis stage on liver biopsy was superior in patients with a valid LSE (n=97) compared with those with an invalid LSE (n=56) (rs 0.577 vs 0.259; p=0.022). Area under receiving operating characteristics for significant fibrosis was greater when LSE was valid (0.83 vs 0.66; p=0.048). Using an LSE cut-off of 8 kPa, the negative predictive value of valid LSE was superior to invalid LSE for the detection of significant (84% vs 71%) and advanced fibrosis (100% vs 93%).Conclusions Fibroscan requires minimal operator training (≥10 observed on patients), and when a valid LSE is obtained, it is an accurate tool for excluding advanced liver fibrosis. To ensure the diagnostic accuracy of Fibroscan it is essential that the recommended LSE validity criteria are adhered to in routine clinical practice.

AB - Background Fibroscan is a quick, non-invasive technique used to measure liver stiffness (kPa), which correlates with fibrosis. To achieve a valid liver stiffness evaluation (LSE) the operator must obtain all the following three criteria: (1) ≥10 successful liver stiffness measurements; (2) IQR/median ratio <0.30 and (3) ≥60% measurement success rate.Objectives To assess the operator training requirements and the importance of adhering to the LSE validity criteria in routine clinical practice.Methods We retrospectively analysed the LSE validity rates of 2311 Fibroscans performed (1 August 2008 to 31 July 2011) in our tertiary liver outpatients department at the University Hospital Birmingham, UK. The diagnostic accuracy of Fibroscan was assessed in 153 patients, by comparing LSE (valid and invalid) with the modified Ishak fibrosis stage on liver biopsy.Results Learning curve analysis highlighted that the greatest improvement in validity of LSE rates occurs in the operator’s first 10 Fibroscans, reaching 64.7% validity by the 50th Fibroscan. The correlation between LSE and the fibrosis stage on liver biopsy was superior in patients with a valid LSE (n=97) compared with those with an invalid LSE (n=56) (rs 0.577 vs 0.259; p=0.022). Area under receiving operating characteristics for significant fibrosis was greater when LSE was valid (0.83 vs 0.66; p=0.048). Using an LSE cut-off of 8 kPa, the negative predictive value of valid LSE was superior to invalid LSE for the detection of significant (84% vs 71%) and advanced fibrosis (100% vs 93%).Conclusions Fibroscan requires minimal operator training (≥10 observed on patients), and when a valid LSE is obtained, it is an accurate tool for excluding advanced liver fibrosis. To ensure the diagnostic accuracy of Fibroscan it is essential that the recommended LSE validity criteria are adhered to in routine clinical practice.

U2 - 10.1136/postgradmedj-2012-131640

DO - 10.1136/postgradmedj-2012-131640

M3 - Article

C2 - 23924687

VL - 89

SP - 685

EP - 692

JO - Postgraduate Medical Journal

JF - Postgraduate Medical Journal

SN - 0032-5473

IS - 1058

ER -