FibroScan as a recommended modality for diagnosis of non-alcoholic fatty liver disease at the district level: a SWOT analysis

Abstract

Non-Alcoholic Fatty Liver Disease (NAFLD), increasingly known as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is the most common chronic liver condition both globally and in India. FibroScan (vibration-controlled transient elastography; VCTE) provides a non-invasive, rapid, and reproducible alternative to liver biopsy by simultaneously measuring hepatic steatosis through the Controlled Attenuation Parameter (CAP) and liver fibrosis via Liver Stiffness Measurement (LSM). This review article assesses the feasibility and implications of implementing FibroScan in district-level health facilities in India using a structured SWOT (strengths, weaknesses, opportunities, and threats/challenges) analysis. The key strengths of FibroScan include its proven diagnostic accuracy, patient acceptability, and alignment with national non-communicable disease priorities. However, its weaknesses encompass costs, operator dependence, and reduced accuracy in obese patients. Many challenges are faced in the implementation of FibroScan at the district level, including the lack of infrastructure, trained personnel and health care financing. But FibroScan also offers the possibility of earlier case detection, fewer liver biopsies, better public health surveillance, and better preventive lifestyle outreach. Strategic policy integration within the Ayushman Bharat framework and the development of models for public-private partnerships could be very useful in facilitating its decentralized adoption.