Even very accurate test should not be done without solid reason (here elevated LFT, symptoms, abnormal ultrasound etc.). If we did it, we should expect high rate of false positive results. It is all about prevalence of each disease in each population. For fibroscan for example:
"This is relevant as cutoffs generated in secondary care are often applied in primary care without taking into account the marked difference in prevalence. In this situation, a negative test would be very reassuring, although a positive test would have a low likelihood of capturing a true positive and raises the question of needing further confirmatory tests."
We agree with the general comment. Not everyone should have an advanced test but reliance on LFT is not a competent trigger. We believe everyone should track FIB-4 over the years as a first level risk stratifier and liver tests should be considered with any metabolic abnormality.
Yes indeed. Regarding my current liver condition (only high bilirubin directed me to ultrasound which one abnormal apect directed to fibroscan) I had some similar situation about testing. Meanwhile I was for sure diagnosed with Gilbert's Syndrome. If I had not done first routine tests I would not have had ultrasound and now I would not have any concerns... I know that it can go both ways so we will see if it was a good decision...About the situation I was a blood donor for some couple of years. After one donation I was infomed that one of screening test for one of infectious disease was positive (they informed me about it without confirmation test which was a mistake). But they said instead the test was highly accurate (which was true) and I was very probably infected. But I was even before test in low risk population for this disease so after positive result I had higher chance for false positive statistically than true positive. But the test was done and I had to wait for confirmation test which turned out negative. Of course meanwhile I was very uncertain about the result (no one could say I was for 100% sure not infected moreover the disease was rather serious). Funny things the false positive test could have some connection to my potencial liver issue now but it is a long shot and at least for now it was ruled out.
It is always a judgement call as all tests have both positive and negative false results. I prefer a test with a very low false negative and I'm willing to do confirmation testing on positives. I'd rather have a false positive worry for a time than a false sense of safety.
Well that confirms my feelings about women's Healthcare approach! I had HCV 28 years, Fibrosis confirmed with biopsy, 2 CT scans Abd + FLD. The MD that treated my HCV will not admit that I have NAFLD and my labs suck EXCEPT AST, ALT & ALK PHOS. He won't answer! GIVE ME A BREAK!
in reply to
Just like the 2 EKG's that I had indicated old MI rt Atrium states I have PAC's. NOT per the echocardiogram, that's it!
You can have disease if your female and they do nothing! Maybe that should be your predicament!
Ok but when you do fibroscan in general population you should keep it mind that most of them would be false positive. It is not about fibroscan only but all tests. It is science.
Let me try to give you simple example.If you take 100 healthly people with no indications of liver (general population ) problem and they do fibroscan. If someone has F2 result for example most probably would be false positive.
But if you take 100 people with fatty liver and also do the same fibroscan and someone has F2 would have more chance to have true positive (78% according to article that I posted) .
I think sometimes it can be inflammation. But sometimes I think there is not obvious reason. Keep it mind that fibroscan was designed to staging fibrosis and not to diagnose other things.
Yep which has some correlation with fibrosis. But this is not absolute value and scale is different for each disease.It is noninvasive tool which is very helpful. But the golden standard for staging fibrosis is biopsy which also is not perfect (sample error).
"This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS."
" The findings of the current study show that TE has higher predictive accuracy compared with NAFLD fibrosis score or FIB-4, which suggests that these surrogate fibrosis markers are not useful for the detection of significant liver fibrosis in the generalpopulation. This was somehow expected because these tests were derived to diagnose/exclude advanced fibrosis and their performance for significant liver fibrosis is limited. Liver enzymes (aspartate aminotransferase/ALT) also have been proposed to screen for liver disease in subjects with suspected NAFLD.10 Our findings show that almost 75% of subjects with LS ≥ 9.2 kPa had normal ALT levels, indicating that many subjects with significant liver fibrosis could be missed if liver enzyme levels were used for screening of liver fibrosis."
"Conclusions
These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes."
And I had “a general population FibroScan” in 2019. High fat, no fibrosis. 2021 FibroScan… CAP jumped to 400 and I’m looking at NASH F3/F4. I have fought and fought for myself. All my prescriptions are “deadly” to a compromised liver, but I am never heard. Blood work normal…Knowing my body, I registered for a liver study. (Hey, there is a new way of being accepted. “Social media” as opposed to doctor referred… )
I finally feel heard & cared for!
I mean no disrespect, but you have no idea how hard it is being female fighting for a diagnosis. My chart is littered with absurd diagnosis’s. And to make it worse they are labeled, “past history!” So of course anxiety disorder shows up because it begins with “A.” Just because the doctor cannot find the reason for my center chest pain, does not mean I have an anxiety disorder. In my case, the FibroScan and the Fatty Liver Foundation may have just saved my life. I want to re-write my story. Hugs!
Hey, what are your thoughts on fibrosis? My G.I. doc yesterday said two things that upset me. He will wait for the liver biopsy results as “We’ve been having problems with FibroScan” comment dismissed my current results. And when he looked at the study’s most recent blood work, “ Your liver numbers look fine!”These comments make my head spin!
In light of your article, I didn’t understand what they’re feeling was on F3 and F4. Could an autoimmune or inflammation cause a false reading of fibrosis?
I think the best option for you is to wait for your biopsy result. What is your fibroscan result? Kpa? IRQ/median? Anyway biopsy is conclusive in most cases so please just wait.
Well you said you had fatty liver and I assumed high BMI the time when you had fibroscan (2019 or 2021?). Not sure if I am right but your FibroScan in 2019 was F0-F1 (below 7kpa)? And after 2 years it went to F3/F4 (14.2 kpa)? If yes it is somekind of very quick progress and that's why your dr ordered the biopsy to clear it up.
Regarding your current score (2021). Moreover you got your result above 9.2 kpa (which was a cut-off from this one study). Statistically you get more chance to have some degree of fibrosis than someone with your result from seems "healthly general population". But on the other hand your result in 2019 (low kpa fibroscan as I think? ) was statistically very positive not to have fibrosis.
But this only numbers and chances so you cannot diagnose yourself with this alone. Please wait for your biopsy and follow what your hepatologist would say. Alone fibroscan is never enough but of course can help to trigger further steps to make final diagnosis and treatment. Good luck and stay positive.
Thank you. I want to leave you with the clarification that I sought the initial FibroScan, as no doctor would order it. I took advantage of Wayne's SUNN study. My liver numbers are always normal & doctors insist on PPI's. I had my gall bladder removed 20 years ago. (Not functioning and no stones...) I have bile in my stomach & refluxing into esophagus, yet numerous GI specialists report that's not how bile works. It goes into the intestines. I'm truly at a loss as to why I'm dismissed.I even had a specialist explain that the medical community averages "normal" as a percent. I'm guessing, now, by her statement, with obesity rising, Fatty Liver is the new normal. The medical community simply cannot have 20% "normal, and 80% ill. (so they lower the normal and reverse the % of who needs treatment.) THIS IS OUR PROBLEM AT HAND. (at least in the US.)
Very technical but interesting stuff about fibroscan:
"Noninvasive Assessment of Diffuse Liver Diseases Using Vibration-Controlled Transient Elastography (VCTE)"
"The available data indicate that, in patients with NAFLD, VCTE is a highly accurate, noninvasive method for the exclusion of advanced fibrosis and a moderately accurate method for the exclusion of significant fibrosis. According to the EFSUMB and EASL Guidelines and Recommendations on the clinical use of liver ultrasound elastography, “TE can be used in NAFLD patients to confidently exclude severe fibrosis and especially cirrhosis,” with a high negative predictive value (around 90%)"
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