Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

Abstract

Purpose The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses.

Patients and Methods In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months’ follow-up.

Results The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods’ results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy.

Conclusion CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.

Zusammenfassung

Ziel Bei Adenokarzinomen des Pankreas beträgt die globale Genauigkeit der durch endoskopischen Ultraschall gesteuerten Feinnadelaspirationsbiopsie (EUS-FNA) etwa 85 %. Der Einsatz von Kontrastmitteln während der EUS zur Hervorhebung von Gefäßen und nekrotischen Anteilen der pankreatischen Raumforderungen kann eine Verbesserung der gesteuerten Biopsie bewirken. Unser Ziel war zu bewerten, ob die durch harmonischen kontrastverstärkten endoskopischen Ultraschall (CH-EUS) gesteuerte FNA im Vergleich zur konventionellen EUS-FNA in den gleichen pankreatischen Raumforderungen die diagnostische Genauigkeit verbessern kann.

Patienten und Methoden In einer prospektiven Studie wurde bei Patienten mit Pankreasraumforderungen in der CT eine EUS-FNA durchgeführt, gefolgt von der harmonischen CH-EUS mit SonoVue. Ein zweites Aufnahmecluster der CH-EUS-FNA wurde von den kontrastverstärkten Bildern gemacht. Die Enddiagnose basierte auf den Ergebnissen von EUS-FNA und Operation oder den Befunden der Nachsorge nach 12 Monaten.

Ergebnisse Die Enddiagnosen waren Adenokarzinom (n = 35), chronische Pankreatitis (n = 10) und Sonstige (n = 6). Die diagnostische Genauigkeit auf Basis der Histologie der Probe betrug bei EUS-FNA 78,4 % und bei CH-EUS-FNA 86,5 % (p = 0,35). Mit Kombination der Ergebnisse beider Methoden stieg die Genauigkeit auf 94 %. Die zwei falsch-negative EUS-FNA-Fälle wurden durch CH-EUS korrekt wiedergegeben. Weder die Größe der Histologieprobe noch das Auftreten von Nekrosen waren für richtig-positive Malignitätsdiagnosen signifikant.

Schlussfolgerung In unserer kleinen Gruppe hatte die CH-EUS-FNA einen nicht signifikanten zusätzlichen Effekt auf die diagnostische Genauigkeit im Vergleich zur konventionellen EUS-FNA. Das Vorliegen von Nekrosen hatte keine Auswirkung auf die CEUS-FNA-Ergebnisse. Die qualitative Bewertung der Kontrastmittelaufnahme innerhalb der Läsion war bei falsch positiver EUS-FNA von Nutzen.

Key words

pancreas - contrast agents - endosonography - neoplasms - fine-needle aspiration

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