Characterization of Small Solid Tumors in the Pancreas: The Value of Contrast-Enhanced Harmonic Endoscopic Ultrasonography

Abstract

CH-EUS is useful for characterizing conventional EUS-detected solid pancreatic lesions. EUS equipped with contrast harmonic imaging may play an important role in the characterization of small tumors that other imaging methods fail to depict and may improve the diagnostic yield of EUS-FNA.

Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

“…It could play a central role associated to EUS-FNA when the latter gives a negative finding in a suspected lesion. Two recent studies [141,142] showed a higher sensitivity of CH-EUS compared to EUS-FNA for the identification of pancreatic carcinoma. Most of false-negative EUS-FNAs resulted to have a hypoenhancement on CH-EUS examination.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…The qualitative interpretation of the contrast image as hypoenhanced was diagnostic for adenocarcinoma in 80-95 % of patients, presenting the prospect of successful diagnosis in the case of false-negative EUS-FNA [96][97][98] (Figure3). Also, CEUS seemed superior to CT scan in detecting lesions under 2 cm in diameter [98]. In total, a meta-analysis of both power Doppler and harmonic CEUS showed that hypoenhancement was associated with pooled sensitivity of 94% and specificity of 89% [99].…”

“…This latter procedure uses frequencies resulting from non-linear oscillation of microbubbles, and the low mechanical index of the ultrasound machine allows subtraction of the tissue-derived signal from the microvessel of the tumor [95]. The qualitative interpretation of the contrast image as hypoenhanced was diagnostic for adenocarcinoma in 80-95 % of patients, presenting the prospect of successful diagnosis in the case of false-negative EUS-FNA [96][97][98] (Figure3). Also, CEUS seemed superior to CT scan in detecting lesions under 2 cm in diameter [98].…”

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

“…CEH-EUS has also proven to be complementary to EUS-FNA, particularly if FNA is inconclusive; CEH-EUS has correctly diagnosed pancreatic adenocarcinoma in these instances to guide appropriate management. [18][19][20] As CEH-EUS exhibits superior visualization of detecting small lesions compared to traditional EUS, it may assist in pinpointing an appropriate target to increase tissue yield for EUS-FNA. 20,21 Sugimoto et al 22 reported that CEH-EUS-guided FNA was significantly superior to conventional EUS-FNA in obtaining an adequate sample on a single needle pass (60% compared to 25%; P = 0.027).…”

“…[18][19][20] As CEH-EUS exhibits superior visualization of detecting small lesions compared to traditional EUS, it may assist in pinpointing an appropriate target to increase tissue yield for EUS-FNA. 20,21 Sugimoto et al 22 reported that CEH-EUS-guided FNA was significantly superior to conventional EUS-FNA in obtaining an adequate sample on a single needle pass (60% compared to 25%; P = 0.027). This was attributable to improved visualization of SPL such that samples obtained via CEH-EUS-guided FNA were obtained from areas without fibrosis and necrosis.…”