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• W2578331378 abstract "Potential conflict of interest: Nothing to report. REPLY: We recently reported that in a large cohort of patients with biopsy‐proven nonalcoholic fatty liver disease (NAFLD), controlled attenuation parameter (CAP) values by transient elastography were directly and independently linked to increased liver stiffness measurement (LSM) values using the M probe. As a consequence, we reported a progressive increase in rates of false‐positive LSM results for both F2‐F4 and F3‐F4 fibrosis from patients with CAP values in the lower tertile to those in the medium tertile and further to those in the higher tertile.1 Consistent with these data, in patients with NAFLD we suggested an algorithm for a careful LSM interpretation based on CAP values.1 We thank Dr. Karlas and colleagues for their interest in our study. We agree with the authors that both obesity and a high skin to capsule distance could lead to an overestimation of LSM in NAFLD patients and that the XL probe could potentially help to overcome these limitations. However, first, we performed our analyses in both obese and nonobese patients with a fully reliable LSM by M probe—at least 10 valid measurements taking into account LSM values and interquartile range/LSM ratio2—and, second, we have to consider that, while the M probe is in wide use, the availability of XL probe is still limited. In addition, when excluding obese NAFLD patients from our analysis, in the 131 nonobese ones with F0‐F2 fibrosis and with presumed lower skin to capsule distance we confirmed a progressive increase in LSM according to CAP tertiles (6.7 ± 3.0 versus 8.0 ± 2.9 versus 9.0 ± 5.2, P = 0.04 by analysis of variance). Finally, from a practical point of view, the CAP results are readily available in the transient elastography report, whereas skin‐to‐capsule distance and body mass index are not. Consistently, a CAP‐based interpretation would be more user‐friendly and more likely to be adopted in clinical practice. Notably, Lee and colleagues3 recently confirmed that in NAFLD patients who underwent transient elastography using the M probe, CAP values affected the diagnostic performance of LSM for fibrosis and that a CAP‐based modified reading of LSM improved its diagnostic performance. In conclusion, we are fully confident about the strength of our results and the need to validate our diagnostic algorithm in independent cohorts using both M and XL probes, the choice of one of these being also automatically recommended in the latest FibroScan software." @default.
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• W2578331378 date "2017-04-28" @default.
• W2578331378 modified "2023-09-26" @default.
• W2578331378 title "Reply" @default.
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• W2578331378 doi "https://doi.org/10.1002/hep.29065" @default.
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