EUS point shear-wave elastography: A novel approach for noninvasive liver fibrosis assessment

Background: EUS point shear‑wave elastography (EUS‑pSWE) permits near‑field, intraluminal assessment of liver stiffness. Objective: We examined its concordance with vibration-controlled transient elastography (VCTE) and its diagnostic accuracy for advanced fibrosis (F ≥ 3) in an expanded mixed cohort. Methods: One hundred twenty adults (57% men; mean age: 61 ± 10 years; body mass index: 28.9 ± 4.0) undergoing routine endoscopic ultrasound were prospectively enrolled. VCTE stratified fibrosis as F0–1 (<7.0 kPa, n = 96), F2 (7–9.4 kPa, n = 11) and F3‑4 (≥9.5 kPa, n = 13). In all the patients, 10 EUS‑pSWE measurements were performed in each lobe, and the liver stiffness result was the median value of the 10 measurements. Correlation (Pearson’s r ), Bland–Altman agreement, and diagnostic indices for F ≥3 were calculated. Results: Median EUS‑pSWE increased with fibrosis (left lobe: 5.0 ± 0.9, 7.8 ± 1.0, 15.1 ± 3.4 kPa for F0–1, F2, F3–4; P < 0.001). EUS-pSWE correlated strongly with VCTE ( r = 0.89, left; r = 0.88, right; P < 0.0001). AUROC for detecting F ≥3 reached 0.91 (95% confidence interval: 0.85–0.96) for the left and 0.89 (0.83–0.95) for the right lobe. A 10.2 kPa cutoff value for F3 afforded 85% sensitivity, 84% specificity, positive predictive value 72%, and negative predictive value 93%. EUS-pSWE provided lobe-independent stiffness estimates that tracked VCTE closely to recognize advanced fibrosis. Conclusions: Its high diagnostic accuracy across fibrosis stages and ability to integrate seamlessly into routine EUS make EUS-pSWE a valuable tool for comprehensive liver assessment.