Fibroscan
The Fibroscan (transient elastography) is being increasingly used as an alternative to liver biopsy or to help decide whether a patient needs a liver biopsy. It measures liver elasticity, giving a liver stiffness measurement (LSM) in kilopascals (kPa), which indicates the level of liver fibrosis. Fibroscans are quick to perform, convenient for patients, give instant results and are non-invasive, painless and highly accurate in CHB patients with severe fibrosis and cirrhosis (Marcellin et al, 2009). However, Fibroscan readings increase with necro-inflammatory activity, in acute hepatitis, and during biochemical flares of hepatitis and cirrhosis (Wang et al, 2009), and may not be accurate in these circumstances. Severe obesity can affect readings, even with the use of an XL probe (Myers et al, 2012). Fibroscans cannot be used in pregnancy, in patients with ascites or where there is any type of swelling or fluid retention in the abdominal area. NICE (2013) recommends Fibroscan as the initial test for liver disease in adults with CHB (Table 2).