Feasibility and histological basis of predicting post-operative pancreatic fistula by pre-operative shear wave elastography: a prospective study

This study aimed to explore the feasibility and histological basis of pancreatic two-dimensional shear wave elastography (2D-SWE) measurement in predicting post-operative pancreatic fistula (POPF) following partial pancreatectomy and to build a prediction model by pre-operative features. 305 pancreatic or periampullary disease patients were enrolled, divided into a training (n = 203) and a validation group (n = 102). POPF was graded as A (or the so-called “biochemical leak”), B, and C. Spearman correlation analysis assessed the histological basis of 2D-SWE measurement value’s (Emean’s) relationship with POPF grades. Multivariate logistic regression analyzed risk factors of POPF occurrence in the training group, and a predictive model was built. The discrimination ability of the model to differentiate POPF grades was analyzed by the area under the receiver operating characteristic curve (AUC). Emean could discriminate between the occurrence and grades of POPF (all AUC > 0.75, p < 0.050). Pancreatic fibrosis and acinar atrophy correlated with both Emean and POPF (all p < 0.050). The higher BMI (p = 0.002), non-dilated pancreatic duct (p = 0.001), and lower Emean (p < 0.001) were the independent risk factors of POPF occurrence and could help discriminate the occurrence of different grades of POPF in both groups (all AUC > 0.80, p < 0.050). Lower pancreatic 2D-SWE measurements indicated a higher risk of POPF, and the histological basis may lie in 2D-SWE’s correlation with pancreatic fibrosis and acinar atrophy. A model integrating pancreatic 2D-SWE measurements, BMI, and the presence of pancreatic duct dilation could predict POPF risk across varying severity levels.