EUS Shear Wave Elastography for Assessing Pancreatic Fibrosis: An Exploratory Study of Its Histological Correlation

OBJECTIVES: Endoscopic ultrasound shear wave elastography (EUS-SWE) enables quantitative, noninvasive assessment of tissue elasticity. However, the association between EUS-SWE and pancreatic histology remains unclear. This study aimed to investigate the utility of EUS-SWE for predicting pancreatic fibrosis by comparing it with histological findings of resected specimens. METHODS: Patients who underwent EUS-SWE before pancreatectomy between October 2019 and October 2024 were retrospectively enrolled. SWE was performed near the surgical resection margin, and shear wave velocity (Vs, m/s) was measured. The number of EUS morphological findings according to the Rosemont classification was obtained. Histological findings were assessed using quantitative analysis and grading analysis. The association between EUS-SWE or the number of EUS morphological findings and histological findings, as well as the diagnostic performance of EUS-SWE and EUS morphological findings for predicting histological fibrosis at predefined fibrosis thresholds (≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20%) was evaluated. RESULTS: Thirty-four patients were included. Vs correlated significantly with quantitative fibrosis (ρ = 0.73, p < 0.001), but not with fatty infiltration and inflammation. The number of EUS morphological findings correlated only with fibrosis grade (ρ = 0.35, p = 0.041). EUS-SWE had higher diagnostic accuracy than EUS morphological findings for predicting histological fibrosis at all thresholds (91.2%, 88.2%, 82.4%, and 88.2% vs. 55.9%, 67.6%, 55.9%, and 50.0%, respectively). CONCLUSIONS: EUS-SWE may serve as a quantitative, noninvasive method for evaluating pancreatic fibrosis. TRIAL REGISTRATION: UMIN ID: 000058397.