Comparative Accuracy of Endosonographic shear wave elastography and Transcutaneous Liver Stiffness Measurement: A pilot study.

BACKGROUND AND AIMS: Vibration-controlled transient elastography (VCTE) is a validated test for assessing liver fibrosis but may be unreliable in select patients, including those with morbid obesity. The limitations of VCTE may be overcome by Endoscopic ultrasound-guided shear wave elastography (EUS-SWE).

METHODS: This single-center, prospective, non-randomized tandem study compared the diagnostic accuracy of EUS-SWE and VCTE in consecutive patients undergoing liver biopsy due to unreliable noninvasive testing. EUS-SWE of the left and right lobes were separately performed and then compared to VCTE. Liver elasticity cut-offs for different stages of fibrosis were estimated viz.: optimized sensitivity and specificity via Youden Index; sensitivity and specificity fixed at 90% each. Diagnostic accuracy for fibrosis was compared to liver histology using AUROC curves. The primary outcome was the diagnostic accuracy of the EUS-SWE for advanced fibrosis. Secondary outcomes included diagnostic accuracy of VCTE, EUS-SWE for left and right hepatic lobes for significant/advanced fibrosis, and cirrhosis.

RESULTS: Forty-two patients (39 men, 54.5±12.1 years) underwent EUS-SWE, VCTE, and liver biopsy. The cross-validated AUROCs (95% CI) for advanced fibrosis were: VCTE: 0.87(0.76-0.97), EUS-SWE left lobe: 0.8(0.64-0.96), and EUS-SWE right lobe: 0.78(0.62-0.95). Corresponding AUROCs (95% CI) for cirrhosis were: VCTE: 0.9(0.83-0.97), EUS-SWE left lobe: 0.96(0.9-1), and EUS-SWE right lobe: 0.9(0.8-1). VCTE was unreliable in 8 patients who successfully underwent EUS-SWE. There was no statistically significant difference in the AUROCs for EUS-SWE and VCTE.

CONCLUSION: EUS-SWE correlates well with liver histology, and is a safe and reliable diagnostic test for assessing liver fibrosis with accuracy comparable to VCTE.