Contrast-enhanced harmonic EUS with novel ultrasonographic contrast (Sonazoid) in the preoperative T-staging for pancreaticobiliary malignancies

Abstract

The depth of invasion of biliary cancer and vascular invasion of pancreatic and biliary cancer could be demonstrated more clearly with CH-EUS compared to H-EUS. CH-EUS has the potential to improve the diagnostic accuracy of preoperative T-staging of pancreaticobiliary malignancies.

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…Using specialized software to interpret contrast data, our results were confirmed in another study where time to peak (TTP) was associated with sensitivity of 93% and specificity of 89% [101]. Using Sonazoid in 91 patients, the CEUS accuracy for detection of pancreatic cancer increased from 84% to 94% with quantitative analysis of TTP [102]. Compared with autoimmune pancreatitis, maximum intensity gain rather than TTP was confirmed as significant for pancreatic cancer contrast uptake [103].…”

Endoscopic Ultrasonography and Contrast-Enhanced Endoscopic Ultrasonography

“…This suggests that, compared with fundamental B-mode imaging, contrast-enhanced harmonic imaging improves the depiction of some pancreatic tumors. Similarly, when Imazu et al [37 ]compared the efficacy of conventional EUS and contrast-enhanced harmonic EUS in terms of preoperative T staging of pancreatobiliary tumors, they found that using contrast-enhanced harmonic EUS, T staging was correct in 24 of 26 pancreatobiliary tumors, 6 of which were misdiagnosed by conventional EUS. In particular, contrast-enhanced harmonic EUS depicts the wall of the portal vein more clearly, which means that it is superior in diagnosing portal vein invasion by pancreatic and bile duct cancers.…”

Endosonography in solid and cystic pancreatic tumors

“…70 Further, CEH-EUS can also improve diagnostic accuracy of preoperative T-staging of pancreaticobiliary malignancies. 71 .…”

“…Potentially, this may improve preoperative T-staging of pancreatic malignancies. 70,71 Despite above advances in technology, histology remains the gold standard. However the combination of EUS-FNA and CEH-EUS could make it the most reliable procedure for assessing solid pancreatic lesions.…”