So far,it has been difficult to assess liver stiffness before surgery without performing a traditional liver biopsy.This study aimed to evaluate the diagnostic performance of two-dimensional shear-wave elastography(SWE)for staging hepatic fibrosis in the background liver parenchyma in patients with liver tumors before hepatic resection.A total of 121 patients were enrolled prospectively who underwent SWE and hepatectomy in the same period between June 2015 and March 2016.Ninety-three of the patients had hepatocellular carcinoma(HCC),6 had intrahepatic cholangiocarcinoma(ICC),6 had HCC mixed with ICC,and the remaining 16 had liver metastases and benign liver tumors.Fibrosis staging in background liver tissue was evaluated according to the METAVIR scoring system.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic performance of SWE.We found that,for primary liver cancer,including HCC and ICC,the SWE values for background liver parenchyma were significantly higher than those for benign liver tumors and liver metastases(12.51 kPa vs.5.85 kPa,P<0.001).More than half of the patients(n=65)were in stage F4,3 patients were in stage F0-1,33 patients were in stage F2,and 20 patients were in stage F3.The median liver stiffness values increased along with the liver fibrosis stage,except in patients with stage F1 liver fibrosis due to the small number of cases(F1,6.7 kPa(range,3.7-7.0 kPa); F2,6.33 kPa(range,3.3-9.4 kPa); F3,9.2 kPa(range,5.9-33.4 kPa); and F4,13.7 kPa(range,5.1-46.2 kPa)).The areas under the ROC curves for the ability of SWE to predict significant fibrosis(≥F2),severe fibrosis(≥F3)and cirrhosis(=F4)were 83.5%(95%confidence interval [CI] 69.7-97.2),91.6%(95%CI 86.7-96.4)and 88.1%(95%CI 81.3-94.8),respectively.The cut off values for SWE according to the Youden index for predicting significant fibrosis(≥F2),severe fibrosis(≥F3)and cirrhosis(=F4)were 7.05 kPa(sensitivity=74.6%,specificity=100.0%),9.45 kPa(sensitivity=78.8%,specificity=100.0%)and 11.1 kPa(sensitivity=83.1%,specificity=89.3%),respectively.In conclusion,our study suggests that SWE could be a useful,accurate and non-invasive method to preoperatively evaluate hepatic fibrosis in patients with liver tumors adapted to hepatectomy.