# Non-invasive assessment of liver fibrosis staging in chronic hepatitis B patients: combining two-dimensional shear wave elastography with serum indicators

## TL;DR

This study shows that combining 2D shear wave elastography with blood tests improves accuracy in diagnosing liver fibrosis stages in chronic hepatitis B patients.

## Contribution

The novel combination of 2D SWE and serum indicators improves noninvasive liver fibrosis staging accuracy in CHB patients.

## Key findings

- Combining serum indicators increased AUC for diagnosing cirrhosis from 0.904 to 0.954.
- Adding 2D SWE to serum indicators improved AUC for substantial fibrosis from 0.805 to 0.889.
- The combined approach offers a noninvasive alternative to liver biopsy for advanced fibrosis stages.

## Abstract

This study aimed to evaluate the diagnostic accuracy of a novel approach that combines noninvasive indicators with two-dimensional shear wave elastography (2D SWE) to assess liver fibrosis stages in patients with chronic hepatitis B (CHB), using the Scheuer score as the reference standard.

2D SWE and serum indicators are commonly used for the noninvasive assessment of liver fibrosis. A total of 102 patients with CHB underwent 2D SWE measurements and serum tests for liver fibrosis markers. Standardized protocols were followed for all diagnostic procedures to ensure reproducibility and consistency. Binary logistic regression was used to generate a combined predictive probability value. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of the noninvasive diagnosis of liver fibrosis stages.

Combining multiple serum indicators increased the AUC for diagnosing substantial liver fibrosis from 0.735 (0.650–0.810) to 0.825 (0.746–0.888) (p = 0.016), for severe liver fibrosis from 0.815 (0.730–0.881) to 0.881 (0.810–0.932) (p = 0.024), and for cirrhosis from 0.904 (0.823–0.923) to 0.954 (0.900–0.984) (p = 0.013). The AUC for diagnosing substantial liver fibrosis increased from 0.805 (0.725–0.858) to 0.889 (0.820–0.939) (p = 0.040) with the combined serum indicators and 2D SWE, indicating a clinically meaningful improvement in diagnostic accuracy.

The combination of multiple noninvasive indicators can improve the accuracy of assessing liver fibrosis stages in patients with CHB. This approach offers a potential noninvasive alternative to liver biopsy for assessing liver fibrosis, particularly in advanced stages that require clinical intervention.