Targeting Liver Biopsies For Optimal Biopsy Site In Diffused Liver Disease Using Real-Time Shear Wave Elastography: A Prospective, Single Center Study

Abstract

Objective: The study aimed to pinpoint the precise site for liver biopsy using ultrasound and elastography guidance and to assess and compare the diagnostic accuracy of shear wave elastography (SWE) and transient elastography (TE) through histopathological correlation.

Methodology: In this prospective single-centre study, the researchers divided the participants into two groups. One group (Group A) had their biopsy guided by ultrasound, which is a standard imaging technique. The other group (Group B) had their biopsy guided by a newer technique called elastography. For the group with elastography-guided biopsy, the researchers used this technique to find the stiffest part of the liver before taking the biopsy sample.

Results: The study investigated how stiffness throughout the liver (mean liver stiffness) compared to stiffness measured in the biopsy samples (biopsy segment velocities). Even though the overall stiffness didn't differ much between different sections of the liver, the stiffness measured in the biopsy samples itself did vary. This suggests scarring (fibrosis) may not be evenly distributed throughout the liver. There was a strong link between the stiffness measured in the biopsy samples and the overall average stiffness. The traditional technique (TE) worked well for identifying moderate and severe stages of scarring (F2, F3, and F4). The new sound wave technique (SWE) was good at identifying moderate fibrosis (F2) but less accurate for mild stages (F1). However, it performed similarly to the traditional technique for moderate to severe stages (F2 and F3). The new technique (SWE) could distinguish between mild or no scarring and moderate/severe scarring with good accuracy (over 95%) if the stiffness measured by the sound waves was at least 1.92 meters per second (m/s).

Conclusions: This study compared a new sound wave technique (SWE) to a traditional method (TE) for diagnosing liver scarring (fibrosis) in people with chronic liver disease.  The findings suggest that the new technique is just as accurate as the traditional one for diagnosing moderate and severe scarring stages. Importantly, the study also found that scarring may not be evenly distributed throughout the liver.  This is why the new sound wave technique, done at the time of biopsy, may be helpful.  It can potentially help doctors pinpoint the best location for the biopsy sample, which could lead to more accurate diagnoses.