Diagnostic Accuracy Of Hepatic Fibrosis Stage By Real-time Tissue Elastogr-aphy With Viral Hepatitis: A Meta-analysis

Objective:To evaluate the overall accuracy of real-time tissue elastography(RTE) for the staging of liver fibrosis with chronic viral hepatitis,to discover a new non-invasive metho d and quantitative measurement of liver stiffness for clinical reference use.Methods:Systematic retrieval of domestic and foreign literature database for both original Chinese and English-language articles about real-time tissue elastography(RTE) for the sta ging of liver fibrosis with viral hepatitis,the database include:Pub Med,Springer,EMBASE,C NKI,Chinese Journal Full-Text Database(CJFD), Chinese Biomedical Literature Database(CB M);the quality of the studies included in this study was assessed using the Quality Asses sment of Studies of Diagnostic Accuracy included in Systematic Review(QUADAS-2),For each cut-off stage of fibrosis, i.e.,F≥1, F≥2, F≥3, and F≥4(METAVIR), a bivariate random-effects model were used to obtain overall sensitivity and specificity,summary receiver op erating characteristic(SROC) curve was performed and the area under the curve(AUC) w as calculated,the risk of publication bias was judged from funnel plots.Results:1152 articles related were searched,of which 17 studies used in the meta-analysi s. A total of 2238 participants were included, The mean age was 47.2 and 55.6 % of the subjects were men. The chi-square tests of heterogeneity for sensitivity were all significa nt(χ2(15)=24.38,p-value=0.0589 for F≥2; χ2(9)=69.53,p-value<0.001 for F≥3; χ2(14)=35.59,p-value=0.0003 for F≥4.), as were the tests for heterogeneity of specificity(χ2(15)=47.76, p-value<0.001 for F≥2; χ2(9)=83.42, p-value<0.001 for F≥3; χ2(14)=42.11, p-value=0.0001 for F≥4). The significant heterogeneity in both sensitivity and specificit y warrants the use of a random-effects model.Summary sensitivity and specificity were 0.79 and 0.76 for F≥2, 0.72 and 0.73 for F≥3, and 0.76 and 0.82 for F≥4, respectively. And the area under curve(AUC) of summary receiver operating characteristic(SROC) curve o f F≥2 is 0.866,F≥3,0.859;F≥4,0.864,respectively.Conclusions:In clinical application, RTE can be used as noninvasive screening technology, in auxiliary examination of liver disease situation. Aiming at diagnosis and discrimination of all stages of liver fibrosis with chronic viral hepatitis, RTE have not yet reached the hi gh accuracy level and is not a substitute for liver puncture biopsy.