Liver stiffness assessed by elastography for the evaluation of hepatocellular carcinoma risk in patients with fibrosis: a systematic review and meta-analysis

This study aimed to systematically review the highest-quality evidence regarding the cutoff value in kPa for the diagnostic accuracy of ultrasound-based liver elastography in comparison with reference standards, including magnetic resonance imaging (MRI), computed tomography, and liver biopsy. In addition, we assessed the presence of hepatocellular carcinoma (HCC) and its associated implications in clinical and diagnostic contexts. We conducted a search using Medical Subject Headings across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Lilacs for articles published up to June 6, 2024. Of 1,131 studies identified, 33 were eligible and 8 met the quality criteria, as evaluated with the "RTI Item Bank" and "QUADAS-2" tools, following the PICO strategy. The mean elasticity of the liver parenchyma among patients with confirmed HCC was 18.77 kPa (95% CI: 16.28-21.27), making ultrasound liver elastography useful as a predictor of the diagnosis by gold-standard methods such as MRI. Ultrasound elastography is a low-cost, accessible, and noninvasive diagnostic tool capable of estimating liver elasticity in patients with HCC. However, due to the heterogeneity of the articles included in this review, further prospective studies are needed in order to confirm and standardize a cutoff stiffness value for early HCC screening, which could improve patient outcomes, particularly in resource-limited settings.