Differential diagnosis of solid pancreatic masses: contrast‐enhanced harmonic (CEH‐EUS), quantitative‐elastography (QE‐EUS), or both?

Abstract

Background: Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Methods: Sixty-two consecutive patients (mean age 64.3 years, range 32-89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Results: Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n ¼ 45), neuroendocrine tumor (n ¼ 3), inflammatory mass (n ¼ 10), pancreatic metastasis (n ¼ 2), autoimmune pancreatitis (n ¼ 1), and a mucinous cystadenocarcinoma (n ¼ 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4-99.7), 85.5% (95% CI: 74.7-92.2), 91.9% (95% CI: 82.5-96.5), and 91.5% (95% CI: 83.6-99.5), respectively. Conclusion: The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

Value of contrast‐enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta‐analysis

“…A total of 636 articles were originally identified in PubMed, the Cochrane library, and Medline. After application of the inclusion and exclusion criteria, nine articles with a total of 887 patients were selected for the final analysis (Fig. ).…”

“…Contrast‐enhanced harmonic EUS (CH‐EUS) with second‐generation contrast agents is considered an accurate technique for investigation of pancreatic lesions. In fact, the utility of CH‐EUS for the differential diagnosis of pancreatic lesions has been reported in many studies …”

“…In fact, the utility of CH-EUS for the differential diagnosis of pancreatic lesions has been reported in many studies. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Two meta-analyses were previously published on the use of CE-EUS for the diagnosis of pancreatic lesions; 21,22 however, these reports included CE-Doppler EUS and firstgeneration contrast agents. Therefore, we carried out a metaanalysis on the diagnosis of pancreatic cancer using current state-the-art CH-EUS techniques.…”

Elastographic Assessment of Xenograft Pancreatic Tumors

“…However, EUS-guided biopsy is difficult, often requiring multiple punctures to obtain a sufficient number of tissue samples. Several researchers have reported that endoscopic ultrasound elastography can differentiate benign from malignant pancreatic tumors and lymph nodes with high accuracy (Cui et al 2015; Iglesias-Garcia et al 2017). Despite these encouraging results, endoscopic ultrasound elastography is invasive and currently only available on one commercially available system, Hitachi’s EUB-8500 system.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…However, the elastographic features of some tissues remain unclear, and further studies are necessary to establish reliable cut‐off values and improve EUS‐elastography specificity . Consistently, elastography should be combined with contrast‐enhanced EUS (CE‐EUS), color Doppler and B‐mode to improve diagnostic yields and accuracy …”