Can FibroSure Test Replace FibroScan?

What you need to know before spending hundreds of dollars on a specialized blood test

1. Introduction

If your doctor suspects you might have liver scarring (fibrosis), you’ve probably encountered a confusing alphabet soup of tests: FIB-4, FibroSure, FibroScan or liver elastography etc.

Which one do you actually need? And more importantly, is an expensive specialized blood test worth the money when cheaper imaging options exist?

This guide breaks down what each test measures, when the pricier options make sense, and how to have an informed conversation with your doctor.

2. What Is Liver Fibrosis (And Why Does It Matter)?

Your liver is remarkably resilient, it can take a beating for years before showing obvious symptoms. That’s actually the problem. By the time you notice something’s wrong, significant damage may have already occurred.

When your liver is repeatedly injured (from fatty liver disease, hepatitis, heavy alcohol use, or other causes), it tries to heal itself by forming scar tissue. This scarring is called fibrosis. Left unchecked, fibrosis can progress to cirrhosis: severe, widespread scarring that impairs your liver’s ability to function.

Here’s the staging system doctors use:

F0: No fibrosis (healthy liver)
F1: Mild fibrosis (some portal scarring)
F2: Significant fibrosis (scarring extending between portal areas)
F3: Advanced fibrosis (bridging scarring)
F4: Cirrhosis (severe, widespread scarring)

The critical question isn’t whether you have any scarring: it’s whether you have clinically significant fibrosis (F2 or higher) that requires intervention, monitoring, or specialist care.

3. The Testing Landscape: Three Tiers

Think of liver fibrosis tests as falling into three tiers:

Tier 1: Free Calculators (FIB-4)

Uses routine blood tests you probably already have.

Tier 2: Specialized Blood Panels (FibroSure/FibroTest)

Requires a special lab order with proprietary analysis.

Tier 3: Imaging Tests (FibroScan, Ultrasound Elastography, MR Elastography)

Uses physical measurement of liver stiffness.

Let’s examine each one.

4. FIB-4: The Free First Step

One of the first steps for any liver evaluation is a blood based test to measure platelet counts and liver enzymes (AST, ALT).

Once you have that info, you plug that into a formula called Fib-4 at any of the online calculators to get a fib-4 score.

What it is: A simple calculation using four pieces of information: your age and three routine blood tests (AST, ALT, and platelet count).

The formula: > FIB-4 = (Age × AST) / (Platelet count × √ALT)

What it tells you:

FIB-4 Score	Risk Level	What It Means
Below 1.3	Low risk	Advanced fibrosis is unlikely: good news
1.3 – 2.67	Indeterminate	Uncertain: additional testing needed
Above 2.67	High risk	Advanced fibrosis is likely: see a specialist

Why it works: As liver scarring progresses, several changes occur in your blood. Your platelet count often drops because the scarred liver doesn’t produce certain growth factors as efficiently. Liver enzymes like AST may rise as cells become damaged. Age matters because fibrosis typically develops over years.

The good: FIB-4 is free, widely available, and endorsed by major medical societies (AASLD, EASL, AGA) as the recommended first-line screening tool. If your FIB-4 is below 1.3, there’s roughly a 90% chance you don’t have advanced fibrosis.

The limitation: About 25-30% of people land in that gray zone between 1.3 and 2.67, which doesn’t give a clear answer. And if you’re over 65, the score tends to overestimate fibrosis risk (age-adjusted cutoffs may apply).

Bottom line: This should almost always be your starting point. The Fib-4 calculator is free, relies on blood works numbers that you already have and surprisingly accurate at ruling out advanced fibrosis.

5. FibroSure: The Premium Blood Test

Also known as:

FibroTest (brand name used outside the United States)
BioPredictive FibroTest (the company’s official designation)
Biopredictive Panel
FT-AT (when combined with ActiTest for inflammation)

What it is: A proprietary blood panel that measures six specific biomarkers, then runs them through a patented algorithm along with your age and sex.

The six markers:

Alpha-2-macroglobulin: a protein that increases with fibrosis
Haptoglobin: decreases as fibrosis progresses
Apolipoprotein A1: relects liver synthetic function
GGT (gamma-glutamyl transpeptidase): increases with liver injury
Total bilirubin: reflects how well your liver clears waste
ALT: a liver enzyme indicating cell damage

How to interpret results:

FibroSure Score	Equivalent Stage	Meaning
0.00 – 0.21	F0	No fibrosis
0.22 – 0.31	F0-F1	Minimal fibrosis
0.32 – 0.58	F1-F2	Mild to moderate fibrosis
0.59 – 0.72	F3	Advanced fibrosis
0.73 – 1.00	F3-F4	Bridging fibrosis to cirrhosis

The good:

Extensively validated with over 1 million tests performed worldwide
US FDA cleared and available through major labs (LabCorp in the US)
Strong track record across multiple liver diseases (hepatitis C, hepatitis B, fatty liver disease, alcoholic liver disease)
A landmark study showed it performs comparably to FibroScan for detecting significant fibrosis
High “interpretability rate” with more than 95% of tests yield usable results

The limitations:

Cost: Typically $200-400 out of pocket if not covered by insurance
False positives possible with acute inflammation, hemolysis (red blood cell breakdown), Gilbert syndrome, or bile duct obstruction
Requires specific laboratory processing: not all labs can run it
Doesn’t measure liver stiffness directly: it’s still an indirect estimate based on blood markers

6. FibroScan (and Other Elastography): The Physical Measurement

What it is: FibroScan is a device that measures how fast a vibration wave travels through your liver. Stiffer tissue (from scarring) makes waves travel faster. The result is reported in kilopascals (kPa). You can check out our detailed fundamentals of liver elastography article if you want to understand how the liver stiffness numbers are calculated.

How stiffness correlates with fibrosis:

Liver Stiffness	Typical Interpretation
3-7 kPa	Normal liver
~8-9 kPa	Significant fibrosis (F2)
~9-12 kPa	Advanced fibrosis (F3)
Above 12-14 kPa	Cirrhosis (F4)

The good:

Directly measures a physical property of your liver
Quick, painless exam (about 10-15 minutes)
No radiation
Can be repeated easily to track changes over time
Also provides information about portal hypertension risk

The limitations:

Not just fibrosis: Inflammation, recent eating, heart failure, and bile duct problems can all make your liver appear stiffer than it really is
Requires fasting (2-3 hours minimum)
Less reliable in obesity: Excess body tissue can interfere with measurements
Requires specialized equipment not available everywhere
Typically costs $150-350 per exam

Important caveat: An elevated stiffness reading doesn’t automatically mean fibrosis. Your doctor should interpret results alongside your liver enzymes, whether you fasted, and other clinical factors.

7. So How Is FibroSure Different From FIB-4?

This is the key question for many patients considering whether to pay for FibroSure.

Factor	FIB-4	FibroSure
Cost	Free (uses existing labs)	$200-400
Markers used	4 routine tests	6 specialized markers
Algorithm	Public formula	Proprietary
Granularity	3 risk categories	Estimates specific F stage
Indeterminate rate	25-30%	Lower
Validation	Extensive	Extensive
Availability	Any clinic	Requires specific lab

The honest truth: For most patients with fatty liver disease, FIB-4 followed by FibroScan (if FIB-4 is indeterminate) is the current guideline-recommended pathway.

FibroSure occupies a middle ground, more detailed than FIB-4, but not as direct a measurement as elastography.

8. When Does FibroSure Make Sense?

Consider FibroSure in these specific situations:

8.1. When FibroScan isn’t available or feasible

Not every clinic has a FibroScan device and this especially becomes a problem if you live in a small town in midwest US or in southeast US or any of the tier 2 or tier 3 cities and towns in India, far east Asia etc. If the nearest center with fibroscan machine is hours away or has a months-long waitlist than FibroSure becomes indispensable since its easy for any doctor or lab to ship your blood sample to a lab instead of either asking you to go on a trip to get a fibroscan.

8.2. When obesity limits FibroScan accuracy

Very high body weight can make FibroScan readings unreliable. In some cases, even the XL probe designed for larger patients produces inconsistent results. FibroSure isn’t affected by body size.

8.3. When you have conditions that falsely elevate liver stiffness

Heart failure, severe inflammation, or bile duct problems can make elastography readings appear worse than your actual fibrosis stage. FibroSure offers an alternative assessment method.

8.4. When confirmation is needed

Some clinical situations benefit from having two different types of non-invasive tests agree. If FibroScan and FibroSure both indicate low fibrosis risk, that’s more reassuring than either alone. If they disagree, that might prompt closer monitoring or even a biopsy.

8.5. For certain chronic conditions with specific validation

FibroSure has particularly strong validation data in chronic hepatitis C and hepatitis B. If you have one of these conditions, your hepatologist may prefer it.

8.6. When tracking changes over time

Serial FibroSure measurements can track whether your liver is improving or worsening, which can be useful if you’re making lifestyle changes or undergoing treatment.

9. When FibroSure Probably Isn’t Worth It

9.1 If your FIB-4 is clearly low

A FIB-4 below 1.3 already has roughly 90% negative predictive value for advanced fibrosis. Spending $300 to confirm what a free test already told you usually isn’t worthwhile.

9.2 If FibroScan is readily available

Modern guidelines favor elastography as the next step after indeterminate FIB-4 because it directly measures liver stiffness and can also assess portal hypertension risk, something FibroSure can’t do.

9.3 If cost is a significant concern

The difference between a $300 blood test and a $200 FibroScan may not seem huge, but for many patients, every dollar matters. If your insurance covers FibroScan but not FibroSure (or vice versa), that’s often the deciding factor.

10. The Current Guideline Pathway

Here’s what major liver disease societies currently recommend for fatty liver disease screening:

Step 1: Calculate FIB-4 (free, using routine labs)
           ↓
    ┌──────┴──────┐
    ↓             ↓
FIB-4 < 1.3   FIB-4 1.3-2.67    FIB-4 > 2.67
    ↓             ↓                  ↓
Low risk      Get FibroScan     High risk
(reassess         ↓             Hepatology
in 2-3 yrs)   Stiffness <8:     referral
              Low risk
              Stiffness ≥8:
              Specialist evaluation

Notice that FibroSure doesn’t appear in this standard pathway, not because it’s a bad test, but because FibroScan is generally preferred when available. However, FibroSure can substitute when elastography isn’t accessible or feasible.

11. Questions to Ask Your Doctor

If you’re trying to decide between these tests, here are some questions worth asking:

“What’s my FIB-4 score?” Start here. If it’s below 1.3, you may not need any additional testing right now.
“Is FibroScan available at this clinic or nearby?” If it’s readily accessible, that’s usually the preferred next step over FibroSure.
“Are there any factors that might make FibroScan less reliable for me?” Obesity, heart failure, or acute liver inflammation might tip the scales toward FibroSure.
“Will my insurance cover FibroSure/FibroScan?” Coverage varies widely. Getting pre-authorization can prevent surprise bills.
“What will the result change about my treatment?” If the answer is “nothing,” the test may not be necessary regardless of which one you choose.

12. The Bottom Line

For most patients with suspected liver fibrosis:

Start with FIB-4. It’s free, accurate, and should be your baseline.
If FIB-4 is indeterminate (1.3-2.67), FibroScan is usually the next step when available.
FibroSure is a reasonable alternative: when FibroScan isn’t accessible, when body habitus limits elastography, or when your doctor wants confirmation from a different testing methodology.
Don’t pay for FibroSure if your FIB-4 is already clearly low: that’s spending money to answer a question you’ve already answered.

The goal isn’t to collect the most tests. It’s to get enough information to make good decisions about your care; whether that means reassurance, lifestyle changes, medication, or specialist referral.

13. Quick Reference: Names for FibroSure

If you see any of these terms, they’re referring to the same test or related panels:

FibroSure: US brand name
FibroTest: Brand name used outside the US (Europe, Canada, etc.)
BioPredictive FibroTest: Company’s official name
FT/AT or FibroTest-ActiTest: Combined fibrosis and inflammation assessment
FibroMax: Extended panel including fibrosis, steatosis, and inflammation markers
SteatoTest: Related test for fatty liver (often bundled)
NashTest: Related test specifically for NASH inflammation

This article is for informational purposes only and doesn’t constitute medical advice. Always discuss testing decisions with your healthcare provider, who can consider your specific medical history, risk factors, and insurance coverage.