Liver fibrosis is the end result of the majority of liver diseases which includes but is not exclusive to hepatits B, hepatits C, NAFLD/NASH, alcoholic liver disease, iron overload, haemachromatosis and autoimmune hepatitis. Liver fibrosis does not produce signs or symptoms, nor are there specific blood markers to determine the degree of fibrosis. Over time, the accumulation of liver fibrosis can result in cirrhosis (severe fibrosis). It is at this end-stage that clinical and biochemical features are present but treatment options are often limited or non-existent. The presence of cirrhosis and its sequelae has a substantial impact on a person’s morbidity and mortality. It is beneficial to identify the presence of liver fibrosis before it becomes severe and complications arise.
Until recently, liver biopsy has been the sole method to quantify fibrosis. This procedure is invasive, painful and carries the risk of bleeding and infection. These complications make liver biopsy an undesirable procedure to have performed repeatedly to monitor liver fibrosis. The procedure is costly and prone to sampling error due to the small volume of liver sampled with each biopsy, heterogeneity of fibrosis throughout the liver and interobserver variability in the interpretation of the specimen.
Who should have one? Why is it useful?
Any individual with suspected liver disease should be considered for a Fibroscan®. Conditions include hepatitis B & C, NAFLD/NASH, alcoholic liver disease, HIV, thalassaemia, haemophillia and cystic fibrosis (see referral form link on the right side of this page). Determining liver fibrosis will assist disease staging, guide prognosis and aid in treatment decisions. It can be performed on a yearly basis to track liver fibrosis progression or regression. Determining the degree of fibrosis is particularly important for patients with hepatitis B & C as this has significant implications for their therapy.
What are the limitations?
Fibroscan® detects minimal disease (F1) and diagnoses cirrhosis (F4) with approximately a 95% positive predictive value. It is not as accurate at differentiating between intermediate stages of fibrosis (F2 or F3). Fibroscan® has the potential to be less effective in certain populations. Obese individuals have a higher rate of measurement failure or uninterpretable results, however this is minimised with the use of a specially designed ‘XL’ probe. Liver inflammation can also influence readings and individuals with ALT > 5 times the upper limit of normal should wait until their ALT < 2 the upper limit of normal and stable for 3 months prior to having a Fibroscan®.
For the patient
The only preparation required for a Fibroscan® is a 2 hour fast prior to the procedure. There are no out of pocket costs. The patient will be informed of their results, with explanation, proceeding the procedure. The clinic runs every Tuesday and alternative Saturday mornings although other times can be made available upon special request.
How to refer
Please download and print the referral sheet. Indicate the reason for
referral by ticking the appropriate box or writing in the clinical notes section. Please have current (approximately within 4 weeks of the referral) liver function tests (LFT), full blood count (FBC) and INR results accompanying the referral. Finally, include both the patient and your contact details. Once completed – Fax to (03) 9594 2273
What you will receive
Both you and your patient will be mailed a formal report which will provide the liver stiffness measurement and how this relates to the patient. Patients found to have overt cirrhosis will be followed-up in our public outpatient gastroenterology clinics otherwise they will return to your care.