Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Liver and Pancreas Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA.
Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA.
Gastrointest Endosc. 2023 Jan;97(1):35-41.e1. doi: 10.1016/j.gie.2022.08.035. Epub 2022 Aug 29.
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).
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.
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.
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.).
振动控制瞬时弹性成像（VCTE）是一种经过验证的评估肝纤维化的检测方法，但在某些特定患者中可能不可靠，包括病态肥胖患者。EUS 引导的剪切波弹性成像（EUS-SWE）可能可以克服 VCTE 的局限性。
这项单中心前瞻性非随机串联研究比较了 EUS-SWE 和 VCTE 在因不可靠的非侵入性检测而接受肝活检采样的连续患者中的诊断准确性。分别进行 EUS-SWE 的左叶和右叶，然后与 VCTE 进行比较。使用 Youden 指数优化灵敏度和特异性来估计不同纤维化阶段的肝弹性截断值；并将灵敏度和特异性固定在 90%，使用受试者工作特征曲线下面积（AUROC）比较纤维化的诊断准确性与肝组织学。主要结局是 EUS-SWE 对晚期纤维化的诊断准确性。次要结局是 VCTE 的诊断准确性、EUS-SWE 对左、右肝叶显著/晚期纤维化和肝硬化的诊断准确性。
42 名患者（39 名男性，年龄 54.5±12.1 岁）接受了 EUS-SWE、VCTE 和肝活检采样。经交叉验证的晚期纤维化 AUROCs 如下：VCTE，0.87（95%置信区间[CI]，0.76-0.97）；EUS-SWE 左叶，0.8（95%CI，0.64-0.96）；EUS-SWE 右叶，0.78（95%CI，0.62-0.95）。肝硬化的相应 AUROCs 如下：VCTE，0.9（95%CI，0.83-0.97）；EUS-SWE 左叶，0.96（95%CI，0.9-1）；EUS-SWE 右叶，0.9（95%CI，0.8-1）。8 名成功接受 EUS-SWE 的患者 VCTE 不可靠。EUS-SWE 和 VCTE 的 AUROC 之间没有统计学上的显著差异。
EUS-SWE 与肝组织学相关性良好，是一种安全可靠的诊断检测方法，其评估肝纤维化的准确性可与 VCTE 相媲美。（临床试验注册号：NCT04533932）。
