Performance of two-dimensional shear wave elastography and transient elastography compared to liver biopsy for staging of liver fibrosis

Abstract

Background: Staging of liver fibrosis traditionally relied on liver histology; however, transient elastography (TE) and more recently two-dimensional shear wave elastography (2D-SWE) evolved to noninvasive alternatives. Hence, we evaluated the diagnostic accuracy of 2D-SWE assessed by the Canon Aplio i800 ultrasound system using liver biopsy as reference and compared the performance to TE. Methods: In total, 108 adult patients with chronic liver disease undergoing liver biopsy, 2D-SWE and TE were enrolled prospectively at the University Hospital Zurich. Diagnostic accuracies were evaluated using the area under the receiver operating characteristic (AUROC) analysis, and optimal cut-off values by Youden's index. Results: Diagnostic accuracy of 2D-SWE was good for significant (≥F2; AUROC 85.2%, 95% confidence interval (95%CI):76.2–91.2%) as well as severe fibrosis (≥F3; AUROC 86.8%, 95%CI: 78.1–92.4%) and excellent for cirrhosis (AUROC 95.6%, 95%CI: 89.9–98.1%), compared to histology. TE performed equally well (significant fibrosis: 87.5%, 95%CI: 77.7–93.3%; severe fibrosis: 89.7%, 95%CI: 82.0–94.3%; cirrhosis: 96%, 95%CI: 90.4–98.4%), and accuracy was not statistically different to 2D-SWE. 2D-SWE optimal cut-off values were 6.5, 9.8 and 13.1 kPa for significant fibrosis, severe fibrosis and cirrhosis, respectively. Conclusions: Performance of 2D-SWE was good to excellent and well comparable with TE, supporting the application of this 2D-SWE system in the diagnostic workup of chronic liver disease.