RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-118829
Endoscopic ultrasound in diagnosis of solid pancreatic lesions: Elastography or contrast-enhanced harmonic alone versus the combination
Publikationsverlauf
submitted 23. Mai 2017
accepted after revision 24. Juli 2017
Publikationsdatum:
08. November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201711/lookinside/thumbnails/925_10-1055-s-0043-118829-1.jpg)
Abstract
Background and study aims Endoscopic ultrasound (EUS) elastography (EUS-E) and contrast-enhanced harmonic EUS (CH-EUS) are useful methods for the diagnosis of pancreatic lesions. This study aims to compare the accuracy of combined EUS-E and CH-EUS with that of EUS-E or CH-EUS alone in the differential diagnosis of pancreatic solid lesions.
Patients and methods One hundred thirty-six patients with solid pancreatic lesions underwent EUS with both EUS-E and CH-EUS were included. Diagnoses were classified as adenocarcinoma, neuroendocrine tumor (NET), and inflammatory pseudotumor in 95, 22, and 19 patients, respectively. EUS records in each case were rearranged into 3 groups: EUS-E, CH-EUS, and combination. Each modality was randomly reviewed by 3 reviewers with different levels of clinical experience. Sensitivity, specificity, and accuracy of each modality according to each diagnosis group were evaluated. For the combined diagnosis populations, the proportions of correct diagnoses among the 3 modalities were compared by using the multivariate logistic regression analysis.
Results The accuracies of EUS-E, CH-EUS, and the combination of them were 68.4 %, 65.4 %, and 75.7 %, respectively, for adenocarcinoma group; 83.8 %, 82.4 %, and 86.8 % for NET group; 80.1 %, 78.7 %, and 81.6 % for inflammatory pseudotumor group. The multivariate logistic regression analysis for the combined diagnosis populations showed that the proportion of correct diagnoses when EUS-E and CH-EUS were combined was slightly higher than with the other 2 modalities, although the significant differences among them were not observed.
Conclusion EUS-E and CH-EUS combined may improve differential diagnosis of solid pancreatic lesions compared with use of the individual modalities.
-
References
- 1 Hirooka Y, Kuwahara T, Irisawa A. et al. JSUM ultrasound elastography practice guidelines: pancreas. J Medical Ultrasonics 2015; 42: 151-174
- 2 Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc 2007; 65: 971-978
- 3 Kuwahara T, Hirooka Y, Kawashima H. et al. Quantitative diagnosis of chronic pancreatitis using EUS elastography. J Gastroenterol 2017; 52: 868-874
- 4 Hu DM, Gong TT, Zhu Q. Endoscopic ultrasound elastography for differential diagnosis of pancreatic masses: a meta-analysis. Dig Dis Sci 2013; 58: 1125-1131
- 5 Hirooka Y, Itoh A, Kawashima H. et al. Contrast-enhanced endoscopic ultrasonography in digestive diseases. J Gastroenterol 2012; 47: 1063-1072
- 6 Fusaroli P, Spada A, Mancino MG. et al. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol 2010; 8: 629-634 (e621 – 622)
- 7 Giovannini M, Hookey LC, Bories E. et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy 2006; 38: 344-348
- 8 Serra C, Felicani C, Mazzotta E. et al. Contrast-enhanced ultrasound in the differential diagnosis of exocrine versus neuroendocrine pancreatic tumors. Pancreas 2013; 42: 871-877
- 9 Saftoiu A, Iordache SA, Gheonea DI. et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc 2010; 72: 739-747
- 10 Hocke M, Ignee A, Dietrich CF. Advanced endosonographic diagnostic tools for discrimination of focal chronic pancreatitis and pancreatic carcinoma--elastography, contrast enhanced high mechanical index (CEHMI) and low mechanical index (CELMI) endosonography in direct comparison. Z Gastroenterol 2012; 50: 199-203
- 11 Bosman FT, World Health Organization, International Agency for Research on Cancer. WHO classification of tumours of the digestive system. 4th ed. Lyon: International Agency for Research on Cancer; 2010: 417
- 12 Ito T, Hijioka S, Masui T. et al. Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan. J Gastroenterol 2016; 52: 9-18
- 13 Matsubara H, Itoh A, Kawashima H. et al. Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases. Pancreas 2011; 40: 1073-1079
- 14 Iordache S, Costache MI, Popescu CF. et al. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA. Med Ultrason 2016; 18: 18-24
- 15 Li X, Xu W, Shi J. et al. Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: a meta-analysis. World J Gastroenterol 2013; 19: 6284-6291