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Endoscopy 2010; 42(7): 564-570
DOI: 10.1055/s-0030-1255537
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study

B.  Napoleon1 , 2 , M.  V.  Alvarez-Sanchez1 , 2 , R.  Gincoul2 , B.  Pujol1 , C.  Lefort1 , 2 , V.  Lepilliez2 , M.  Labadie3 , J.  C.  Souquet2 , P.  E.  Queneau2 , J.  Y.  Scoazec4 , J.  A.  Chayvialle2 , T.  Ponchon2
  • 1Department of Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
  • 2Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France
  • 3Cabinet d’anatomopathologie, 41, Allée des Cyprès, Limonest, France
  • 4Department of Pathology, Hôpital Edouard Herriot, Lyon, France
Further Information

Publication History

submitted 02 September 2009

accepted after revision 09 March 2010

Publication Date:
30 June 2010 (online)

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Commentaire de travail de B. Napoleon et al., pp. 564Endoscopy 2010; 42(07): 611-611
DOI: 10.1055/s-0031-1291880

Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope.

Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months.

Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS.

Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.

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B. Napoleon MD

Department of Gastroenterology
Hôpital Privé Jean Mermoz

55 avenue Jean Mermoz
69008 Lyon
France

Fax: +33-478-742655

Email: dr.napoleon@wanadoo.fr