Diagnostic value of endoscopic ultrasonography combined with liver stiffness measurement and liver histopathology for early liver cirrhosis

Abstract

Objective To evaluate the value of endoscopic ultrasonography(EUS) alone for early liver cirrhosis and the diagnostic efficacy of EUS combined with liver histopathology (LH) and liver stiffness measurement (LSM) for early liver cirrhosis. Methods Data of 226 patients with chronic liver lesions who underwent endoscopy and EUS at Tianjin Second People's Hospital were collected to assess esophageal and gastric varices. Liver fibrosis was assessed by LH and LSM was determined by Fibroscan. Models of EUS-LSM, EUS-LH, LSM-LH, ELL (EUS, LSM and LH) were constructed to predict early liver cirrhosis. The ROC curve and AUROC were used to evaluate the efficacy of different models in the diagnosis of early liver cirrhosis. Results A total of 149 patients were diagnosed as chronic liver disease and 77 patients were diagnosed as early liver cirrhosis (Child-Pugh A grade) by clinical evaluation. Ratio of varices found by EUS was significantly higher than that by endoscopy [68.8% (53/77) VS 32.5% (25/77), P<0.05]. The cut-off value was 8.65 kPa by LSM to predict early liver cirrhosis. Pseudolobules were confirmed by LH in 42(54.5%) patients in the early liver cirrhosis group. The AUROC of ELL was 0.919 (95%CI: 0.875-0.951), sensitivity=0.792, specificity=0.913, PPV=0.824, NPV=0.895, + LR=9.08, -LR=0.23, accuracy=0.872, and ELL was superior to EUS (P<0.000 1), LSM (P<0.000 1), LH (P<0.000 1), EUS-LSM (P<0.000 1), EUS-LH (P=0.013 4) and LSM-LH (P=0.002 2) in the diagnosis of early liver cirrhosis. Conclusion EUS is superior to endoscopy in detecting the varices for early liver cirrhosis. Combination of EUS with LSM and LH can improve diagnostic efficacy for early liver cirrhosis. Key words: Ultrasonography; Pathology; Liver cirrhosis; Liver stiffness measurement