Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses

Abstract

CH-EUS is useful for distinguishing between pancreatic adenocarcinoma and other pancreatic disease. When a pancreatic mass shows a hypoenhanced pattern on CH-EUS but involves either insufficient samples or negative results with EUS-FNA, clinicians might consider performing another pathologic diagnosis on the basis of an EUS-FNA sample or a biopsy.

Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

“…Both techniques have an excellent accuracy, with a high sensitivity and low specificity reported in published meta-analyses [11][12][13][14][15]. RTE-EUS has a high sensitivity (95-100%) but a lower specificity varying widely (22-74%) [11][12][13].…”

“…CEH-EUS represents a useful method to characterize vascular pattern of the pancreatic masses and hence to differentiate pancreatic adenocarcinomas from benign masses, with high sensitivity (up to 95%) and specificity (90%) [14]. Other studies were not so optimistic, indicating a sensitivity of 92% with a specificity of 68% [15]. Anyway, a hypovasculartumor is highly predictive for pancreatic adenocarcinoma [14,15].…”

“…Other studies were not so optimistic, indicating a sensitivity of 92% with a specificity of 68% [15]. Anyway, a hypovasculartumor is highly predictive for pancreatic adenocarcinoma [14,15]. Combined use of contrast-enhancement and elastography during the same EUS examination also has demonstrated a good sensitivity and specificity (75.8%, 95.2%, respectively) [16].Technically, they can be easily performed during EUS examinations, with a minimal prolongation of the examination time and virtually no complications, based on the excellent safety profile of microbubble ultrasound contrast agents.…”

“…Real-time elastographic EUS (RTE-EUS) and contrast-enhanced harmonic EUS (CEH-EUS) are two useful methods for the assessment of patients with focal pancreatic masses both reported to have a high sensitivity and specificity [11][12][13][14][15][16]. The high negative predictive value of the combination between elastography and contrast enhancement during EUS as reported [16] has raised hopes that these imaging methods might help the clinical decision making the process of differentiation between benign and malignant focal pancreatic masses, especially in patients with negative EUS-FNA samples.…”

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).…”