Combination of EUS‐FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: A prospective single‐blinded study

Kongkam, Pradermchai; Lakananurak, Narisorn; Navicharern, Patpong; Chantarojanasiri, Tanyaporn; Aye, Khin Myo; Ridtitid, Wiriyaporn; Kritisin, Krit; Angsuwatcharakon, Phonthep; Aniwan, Satimai; Pittayanon, Rapat; Sampatanukul, Pichet; Treeprasertsuk, Sombat; Kullavanijaya, Pinit; Rerknimitr, Rungsun

doi:10.1111/jgh.13067

Cited by 47 publications

(27 citation statements)

References 25 publications

(76 reference statements)

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“…Computer-aided diagnosis techniques might improve the accuracy for the differential diagnosis of focal pancreatic masses, with artificial neural networks being used most often [154,156]. Several multicenter studies [155,156,194] and other prospective studies [135,149,150,152,177,197,198] consistently showed a very high sensitivity (over 90 %), but considerably lower specificity and negative predictive values for the diagnosis of benign versus malignant focal pancreatic masses. These findings have been summarized in meta-analyses, affirming the very high sensitivity (95 % -99 %) and negative predictive value of EUS-SE, but limited specificity (64 % -76 %) and positive predictive value to diagnose pancreatic malignancy [172, 189 -192].…”

Section: Pancreatic Ductal Adenocarcinoma and Other Solid Pancreatic mentioning

confidence: 99%

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

et al. 2019

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Section: Pancreatic Ductal Adenocarcinoma and Other Solid Pancreatic mentioning

confidence: 99%

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

et al. 2019

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“…It has been identified as a sensitive modality to assist with the diagnosis of PDAC during EUS-guided FNA, but is presently limited by poor specificity. 11,21 Similarly, RNA sequencing has been shown to distinguish malignant from benign lesions with high sensitivity (87%) but lower specificity (75%). In addition, there was inadequate RNA in 9 of the 48 enrolled subjects, limiting this adjunct in a similar way to cytopathology.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10] Elastography, fluorescence in situ hybridization, K-RAS analysis, microRNAs, immunostaining, and RNA-sequencing analysis have all been proposed as supplementary tests to cytopathology, but none have gained widespread use. [11][12][13][14] Here, we explore the inflammatory milieu of the PDAC microenvironment as a potential diagnostic supplement to cytopathology. Desmoplastic stroma represents as much as 80% of the overall PDAC tumor volume.…”

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confidence: 99%

Protein Signatures and Tissue Diagnosis of Pancreatic Cancer

Underwood

Gerber

Nguyen

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration fails to diagnose up to 25% of patients with pancreatic ductal adenocarcinoma (PDAC). Proteomics can help to overcome this clinical dilemma. We hypothesized that soluble protein signatures can differentiate PDAC from benign tissues. STUDY DESIGN: Tissues were obtained from resected surgical specimens, lysed, and homogenates collected for analysis with a 41-protein multiplex assay. Analyte concentrations were normalized to total protein. Statistical analysis was performed to evaluate for differences in PDAC vs benign tissue. RESULTS: Tissues were obtained from 159 patients, 82 patients with PDAC naïve to therapy and 77 with benign pancreatic pathology. Fourteen analytes had a receiver operating characteristic curve area of >0.75 for predicting PDAC vs benign tissue. A recursive partitioning model using only 2 analytes, interleukin 1 receptor antagonist and transforming growth factor-a, provided an accuracy, sensitivity, and specificity of 91.2%, 90.2%, and 92.2%, respectively. A penalized logistic regression model found 12 analytes that provide diagnostic value to a protein signature. The mean area under the receiver operating characteristic after 50 tenfold cross-validations was 0.951. Accuracy, sensitivity, and specificity of this model were 91.2%, 87.8%, and 94.8%, respectively. Applying the scenario of 80% disease prevalence in patients undergoing endoscopic ultrasound with fine-needle aspiration for a pancreatic head mass, positive predictive value is 98.5% (95% CI 93.0% to 99.7%) and negative predictive value is 66.0% (95% CI 54.9% to 75.6%). CONCLUSIONS: Protein signatures from pancreatic specimens can differentiate PDAC from benign tissue. Additional work to validate these findings in a unique sample set is warranted.

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“…Elastography can be used to evaluate tissue stiffness and to assess the elasticity of solid lesions. Some studies have shown that EUS guided elastography is useful in improving diagnostic yield and efficiency of EUS-FNA of solid pancreatic lesions, however, this remains controversial [6,7,8,9].…”

Section: Introductionmentioning

confidence: 99%

The Role of Real-Time Endoscopic Ultrasound Guided Elastography for Targeting EUS-FNA of Suspicious Pancreatic Masses: A Review of the Literature and a Single Center Experience

Sachdev

Jaffri

Khanna

et al. 2016

American Journal of Gastroenterology

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Background-Endoscopic ultrasound guided elastography is an imaging modality that can be used to evaluate tissue stiffness and to assess solid pancreatic lesions. It can also assist in optimizing the diagnostic yield of endoscopic ultrasound guided fine needle aspiration biopsies. Aims-To review the literature on solid pancreatic lesions, the use of EUS guided fine needle aspiration and endoscopic ultrasound guided elastography and to present a single center experience using elastography to direct fine needle aspiration biopsies of solid pancreatic lesions. Methods-We present a review of the literature and a single center experience describing the use of EUS guided elastography in directing fine needle aspiration biopsies of solid pancreatic lesions. Results-Thirteen male veterans with an average age of 62.3 (SD±11.8) years were enrolled in the study. The mean pancreatic mass size on EUS was 5.1×5.2 (SD±4.4×4.5) cm. A total of 13 lesions were identified during elastography. The lesions were most commonly found in the body (n=5), followed by multifocal lesions (n=4), pancreatic head (n=3) and tail (n=1). The seven concerning pancreatic lesions were stratified based on color pattern identified on EUS and EUSelastography. Three lesions were homogenously blue, and four lesions were heterogeneously blue. The remaining six lesions which were less concerning were predominantly green. Of the three lesions, that were homogenously blue, two were diagnosed as adenocarcinoma (n=2) and chronic pancreatitis (n=1) respectively. Of the four heterogeneously blue lesions two were adenocarcinomas, while the other two represented a large B-cell lymphoma and chronic pancreatitis. Patients whose lesions were characterized as homogenous or heterogeneous green were benign and remained disease free after a median of two years of regular follow up. Limitations-Relatively small number of patients studied. Conclusions-In our single center experience we found that the use of real time endoscopic ultrasound guided elastography for targeting fine needle aspiration of suspicious pancreatic lesions

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Combination of EUS‐FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: A prospective single‐blinded study

Cited by 47 publications

References 25 publications

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

Protein Signatures and Tissue Diagnosis of Pancreatic Cancer

The Role of Real-Time Endoscopic Ultrasound Guided Elastography for Targeting EUS-FNA of Suspicious Pancreatic Masses: A Review of the Literature and a Single Center Experience

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