Contrast-enhanced harmonic endoscopic ultrasound using time–intensity curve analysis predicts pathological grade of pancreatic neuroendocrine neoplasm

Abstract

Histological grading is important to treat algorism in pancreatic neuroendocrine neoplasms (PNEN). The present study examined the efficacy of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) and time-intensity curve (TIC) analysis of PNEN diagnosis and grading. Methods TIC analysis was performed in 30 patients using data obtained from CH-EUS, and histopathological diagnosis was performed via EUS-guided fine needle aspiration or surgical resection. The TIC parameters were analyzed by dividing them into G1/G2 and G3/NEC groups. Then, patients were classified into non-aggressive and aggressive groups and evaluated. Results Twenty-six patients were classified as G1/G2, and 4 as G3/NEC. From the TIC analysis, five parameters of I; echo intensity change, II; time for peak enhancement, III; speed of contrast, IV; decrease rate for enhancement, and V; enhancement ratio for node / pancreatic parenchyma were obtained. Three of these parameters, I, IV and V, showed high diagnostic performance. Using the cutoff value obtained from the receiver operating characteristic (ROC) analysis, the correct diagnostic rates of parameter I, IV and V were 96.7%, 100%, and 100%, respectively, between G1/G2 and G3/NEC. A total of 21 patients were classified into the non-aggressive group, and 9 into the aggressive group. Using the cutoff value obtained from the ROC analysis, the accurate diagnostic rates of I, IV and V were 86.7%, 86.7%, and 88.5%, respectively, between the non-aggressive and aggressive groups. Conclusion CH-EUS and TIC analysis showed high diagnostic accuracy for grade diagnosis of PNEN. Quantitative perfusion analysis is useful to predict PNEN grade diagnosis preoperatively.

The Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) Guidelines for Contrast-Enhanced Endoscopic Ultrasound

“…Analysis software has been developed in an attempt to provide some degree of quantitative assessment for CH-EUS (Seicean et al 2010;Imazu et al 2012;S aftoiu et al 2015;Omoto et al 2017;Takada et al 2019;Buxbaum et al 2020). Although limitations remain in quantitative analysis because of the subjectivity involved in determining a region of interest, combination of qualitative and quantitative analyses may improve the diagnostic ability of CH-EUS.…”

Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms

“…The differential diagnosis between benign and malignant lesions appears to be the main field of application of CH-EUS. CH-EUS may also predict PanNENs aggressiveness as tumors with heterogeneous enhancement have fewer vessels and more fibrosis which are the features associated with more aggressive tumors [84,85]. Concerning pancreatic solid neoplasms, the accuracy of CH-EUS seems comparable to that of EUS-TA.…”

“…In a study including 91 patients with different pancreatic diseases, the diagnostic accuracy based on the time-intensity curve was 88% and rose to 94.7% when considered in combination with EUS B-mode [86]. Moreover, Takada et al, in a study including 26 patients with PanNENs, demonstrated a diagnostic accuracy of time-intensity curve analysis close to 100% to differentiate G1/G2 PanNETs from G3 PanNECs [85].…”

Role of Endoscopic Ultrasound in the Diagnosis of Pancreatic Neuroendocrine Neoplasms

“…Furthermore, Palazzo et al reported that contrast-enhanced harmonic EUS (CH-EUS) can accurately predict aggressive tumor behavior by evaluating the heterogeneous patterns of PNENs, with a sensitivity of 86% and a specificity of 96% [25]. Takada et al reported that CH-EUS with time-intensity curve analysis is useful for PNEN diagnosis and grading [26]. CE-EUS plays an important role in finding a specific site within a lesion that would be more suitable for EUS-FNA.…”