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 EUS-guided shear wave elastography
(EUS-SWE).
Methods
This single-center, prospective, nonrandomized tandem study compared the diagnostic
accuracy of EUS-SWE and VCTE in consecutive patients undergoing liver biopsy sampling
because of unreliable noninvasive testing. EUS-SWE of the left and right lobes were
separately performed and then compared with VCTE. Liver elasticity cutoffs for different
stages of fibrosis were estimated in 3 ways: optimized sensitivity and specificity
using the Youden index; and with sensitivity and specificity fixed at 90% each, Diagnostic
accuracy for fibrosis was compared with liver histology using the area under the receiver-operating
characteristic curve (AUROC). The primary outcome was the diagnostic accuracy of EUS-SWE
for advanced fibrosis. Secondary outcomes were diagnostic accuracy of VCTE, EUS-SWE
for left and right hepatic lobes for significant/advanced fibrosis, and cirrhosis.
Results
Forty-two patients (39 men, aged 54.5 ± 12.1 years) underwent EUS-SWE, VCTE, and liver
biopsy sampling. The cross-validated AUROCs for advanced fibrosis were as follows:
VCTE, .87 (95% confidence interval [CI], .76-.97); EUS-SWE left lobe, .8 (95% CI,
.64-.96); and EUS-SWE right lobe, .78 (95% CI, .62-.95). The corresponding AUROCs
for cirrhosis were as follows: VCTE, .9 (95% CI, .83-.97); EUS-SWE left lobe, .96
(95% CI, .9-1); and EUS-SWE right lobe, .9 (95% CI, .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.
Conclusions
EUS-SWE correlates well with liver histology and is a safe and reliable diagnostic
test for assessing liver fibrosis with accuracy comparable with VCTE. (Clinical trial
registration number: NCT04533932.)
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: August 28, 2022
Accepted:
August 20,
2022
Received:
June 26,
2022
Footnotes
Abbreviations: AUROC, area under the receiver-operating characteristic curve; EUS-SWE, EUS-guided shear wave elastography; NAFLD, nonalcoholic fatty liver disease; NPV, negative predicted value; PPV, positive predictive value; VCTE, vibration-controlled transient elastography.
DISCLOSURE: The following author received research support for this study from Olympus Corporation of the Americas: D. R. Kohli. In addition, the following authors disclosed financial relationships: M. Desai: Research support from Intercept Pharma. M. S. Siddiqui: Advisory board for AMRA and DSMB Sagimet. P. Sharma: Consultant for Lumendi, Olympus, Boston Scientific, Bausch, Medtronic USA, and Fujifilm; research support from Olympus, Medtronic USA, Fujifilm, U.S. Endoscopy, Ironwood, Erbe, Docbot, Cosmo Pharmaceuticals, and CDx Labs; equipment loan from Medtronic Italy. All other authors disclosed no financial relationships.
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