Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma

Kamata, Ken; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hisao; Sakurai, Toshiharu; Nishida, Naoshi; Chikugo, Takaaki; Chiba, Yasutaka; Matsumoto, Ippei; Takeyama, Yoshifumi; Kudo, Masatoshi

doi:10.1016/j.gie.2017.05.052

Cited by 36 publications

(29 citation statements)

References 10 publications

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“…Combination with CH-EUS has improved the sensitivity from 92 % to 100 % [8], suggesting that CH-EUS could help to identify the target for EUS-FNA. In a retrospective study on 192 patients, the presence of an avascular necrotic area decreased diagnostic sensitivity to 72.9 % compared with 94.3 % in patients with no necrotic areas [9]. Similarly to transabdominal ultrasound, CH-EUS can guide FNA (CH-EUS-FNA), avoiding necrotic areas and vessels inside lesions [10].…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial

et al. 2020

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Abstract Background Contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can visualize necrotic areas and vessels inside lesions. CH-EUS findings combined with EUS-guided fine-needle aspiration (EUS-FNA) improves diagnosis in pancreatic solid masses. CH-EUS can also guide EUS-FNA (CH-EUS-FNA), potentially improving the diagnostic rate of EUS-FNA, but such superiority has not been proved in prospective studies. We aimed to assess whether CH-EUS-FNA is superior to standard EUS-FNA for specific diagnosis of solid pancreatic masses and what factors affect the diagnostic rate. Methods This randomized controlled study in one tertiary medical academic center included patients with suspected pancreatic solid masses on transabdominal ultrasound or computed tomography (CT) scan. Two passes with a 22-G standard FNA needle were done using EUS-FNA and CH-EUS-FNA in random order, and the visible core obtained was sent for histological analysis. Final diagnosis was based on EUS-FNA or surgical specimen results and on 12-month follow-up by imaging. Results 148 patients were evaluated. EUS-FNA and CH-EUS-FNA showed diagnostic sensitivities of 85.5 % and 87.6 %, respectively (not significantly different) and the combined sensitivity of the two passes was 93.8 %. The false-negative rate was not significantly different when hypoenhanced or hyperenhanced lesions were compared with the EUS-FNA results. No differences were seen for the results related to location, size, tumor stage, chronic pancreatitis features, or presence of biliary plastic stent. Conclusions The diagnostic rates for samples obtained using 22-G needles with standard EUS-FNA and CH-EUS-FNA were not statistically significantly different.

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Section: Introductionmentioning

confidence: 99%

Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial

et al. 2020

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“…A recent meta-analysis 116 supported the aforementioned hypothesis by demonstrating the superior diagnostic performance of CH-EUS in differential diagnosis of pancreatic masses (sensitivity 94 % [95 % CI, 0.91 – 0.95], specificity 89 % [95 % CI, 0.85 – 0.92], and area under the curve 0.9732). Moreover, CH-EUS was demonstrated to improve EUS-FNA diagnostic sensitivity in lesions with vascular versus avascular areas (94.3 % vs 72.9 %, respectively, P < 0.001) 117 , as well as to reduce the number of required needle passes to reach a diagnosis 118 and increase tissue adequacy 119 . In addition, CH-EUS was shown to be helpful in investigation of pancreatic cysts for differentiating a mural nodule from mucin and in assessing vascularity within the cyst and septations 112 120 .…”

Section: Literature Searchmentioning

confidence: 96%

Endoscopic ultrasonography in pancreatic diseases: advances in tissue acquisition

et al. 2019

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Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) improved the diagnostic performance and upgraded the role of endoscopic ultrasonography (EUS) into an interventional modality, able to guide patient management and treatment.This review aimed to highlight the advances, emerging practices, procedural techniques and technological innovations in EUS tissue acquisition in pancreatic diseases. Methods A thorough review of the literature was performed using PubMed to identify articles that describe techniques, advances, and practices in EUS tissue acquisition in gastrointestinal diseases. Conclusion Since the first EUS-FNA procedure, EUS guided-tissue acquisition has been evolving continuously. Development of needles with innovative tip design enabled procurement of larger samples with preserved histological architecture. Moreover, sampling techniques and complementary methods, such as contrast harmonic imaging and EUS-elastography, have been introduced in an effort to improve diagnostic performance and sample adequacy.

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“…Avascular areas in pancreatic adenocarcinomas have been associated with severe fibrosis and necrosis within these lesions [43]. In addition, avascular (non-enhancing) areas in pancreatic lesions on CH-EUS have been reported to represent areas of necrosis, with EUS-FNA having sensitivities of 72.9% (35/48) and 94.3% (230/244) for lesions with and without avascular areas, respectively, sensitivities that differed significantly [44]. Moreover, samples obtained by puncturing avascular (non-enhancing) areas on CH-EUS were found to contain necrotic tissue and to therefore be inadequate for histological diagnosis, whereas samples obtained by puncturing vascular areas contained malignant cells [45].…”

Section: Targeting Eus-fna With Ch-eusmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) with Image Enhancement

2020

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Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful in the differential diagnosis of solid pancreatic lesions, lymph nodes, and liver lesions, inadequate sampling may result in an incorrect pathological diagnosis. The accuracy of EUS for the evaluation of pancreatobiliary lesions may be increased by image enhancement technologies, including contrast-enhanced harmonic (CH)-EUS and EUS-elastography. These methods can provide information that complement EUS-FNA for the diagnosis and staging of pancreatobiliary cancer, and can help to identify the EUS-FNA target, reducing the requirement for repeat FNA.

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Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma

Cited by 36 publications

References 10 publications

Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial

Contrast-enhanced harmonic versus standard endoscopic ultrasound-guided fine-needle aspiration in solid pancreatic lesions: a single-center prospective randomized trial

Endoscopic ultrasonography in pancreatic diseases: advances in tissue acquisition

Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) with Image Enhancement

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