EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions

Janssen, Jan; Schlörer, E; Greiner, Lucas

doi:10.1016/j.gie.2006.12.057

Cited by 255 publications

(178 citation statements)

References 23 publications

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“…In a subanalysis performed in their study, including only patients with solid pancreatic masses, they described in all of them a similar pattern, mixed heterogeneous green and blue, with an irregular distribution, except in cases of endocrine tumors (with more homogeneous patterns). However, they only included one inflammatory mass in the context of chronic pancreatitis, and it was thus difficult to compare with previous studies, which included a significant, higher number of inflammatory masses (22). Similar data are presented in a recent study including 70 patients with solid pancreatic tumors, and 10 healthy controls.…”

Section: Discussionmentioning

confidence: 93%

Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses: Pancreatic cancer vs. inflammatory mass in chronic pancreatitis

Garcia

Noia

Castro

et al. 2009

Rev. esp. enferm. dig.

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Endoscopic ultrasonography (EUS) is considered one of the most accurate methods for the diagnosis and staging of pancreatic tumors. EUS-guided fine-needle aspiration (FNA) allows to increase the diagnostic accuracy of EUS in this setting; however, it is technically demanding (a pathologist is also essential) and is furthermore associated with small, but not insignificant morbidity. EUS pancreatic elastography, by analyzing tissue stiffness, arises as a new and very useful tool for the differential diagnosis of solid pancreatic masses. Elastography provides specific patterns supporting the benign or malignant nature of the disease. However, there is a handicap related to the subjective interpretation of images. Second-generation elastography has been recently developed, and allows a quantitative analysis of tissue stiffness. It is based on the determination of a strain ratio (obtained after comparing the strain value of the mass to a strain value from a control area in the region under study). We present two cases reflecting the usefulness of second-generation elastography in the differential diagnosis between pancreatic adenocarcinoma and an inflammatory mass in the context of chronic pancreatitis. We found significant differences between both masses in the strain ratio values (25.46% in the pancreatic adenocarcinoma vs. 2.35% in the inflammatory mass). Second-generation elastography is a very useful tool for the differential diagnosis of solid pancreatic masses.Key words: Endoscopic ultrasound. Elastography. Second-generation Elastography. Pancreatic tumors. INTRODUCTIONEndoscopic ultrasonography (EUS) has become a basic tool for the study of pancreatic diseases, and is considered one of the most accurate methods for the diagnosis and staging of both chronic inflammatory and neoplastic pancreatic diseases (1,2). However, differentiation between pancreatic cancer and focal pancreatitis remains a challenge. EUS can guide fine-needle aspiration (EUS-FNA) for the collection of cytological samples from pancreatic lesions with a very high overall diagnostic accuracy (3-7). EUS-FNA may be, however, technically demanding, and multiple puncturing of pancreatic lesions may be needed to obtain adequate material for cytological or microhistological evaluation. EUS-FNA of the pancreas, despite being considered very safe, is furthermore associated with a small, but not insignificant morbidity (8,9).Elastography is a method for the real-time evaluation of tissue stiffness, which has been used for the analysis of superficial organ lesions such as those of the breast (10-13). Images obtained by elastography represent tissue elasticity, which may reflect histopathological differences (14). The association of this technology with EUS has implied a significant advance in the management of pancreatic diseases, mainly in the differential diagnosis of pancreatic tumors (15). A new advance has been recently developed -secondgeneration elastography. This technique allows not only a qualitative elastographic analysis, but also a...

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Section: Discussionmentioning

confidence: 93%

Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses: Pancreatic cancer vs. inflammatory mass in chronic pancreatitis

Garcia

Noia

Castro

et al. 2009

Rev. esp. enferm. dig.

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“…Unfortuntaly, lack of surgical specimens in these patients cannot confirm this hypothesis. However, in a recent publication by Janssen et al [16] , the elastographic patterns of the normal pancreas and the pancreas affected by inflammatory or focal disease were studied. They concluded that elastography does not distinguish between chronic pancreatitis and tumors because of their similar fibrous structure.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical research has shown promising results in differentiating between benign and malignant tissue in the thyroid gland [5] , breast [6][7][8] , prostate [9,10] and to assess liver fibrosis [11][12][13][14] . Recently, elastography has also been introduced during EUS examination [15][16][17][18][19] . The cur rent study is a continuation of previous research [15] to validate the potential role of elastography in distinguishing benign from malignant lymph nodes and focal pancreatic lesions in a large retrospective trial.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study

Giovannini¹,

Botelberge²,

Bories³

et al. 2009

WJG

247

183

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AIM:To evaluate the ability of endoscopic ultrasound (EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes. METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass (n = 121) or lymph node (n = 101). The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration (EUS-FNA) and/or by surgical pathology. An interobserver study was performed. RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION: EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.

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“…Higher ARFI values in acute pancreatitis are due to increased fluid content in the inflamed organ making the tissue hard (Mateen et al, 2012). Another study (Janssen et al, 2007) concluded that chronic pancreatitis and hard tumors cannot be distinguished by elastography, probably because of their similar fibrous structure and calcification, leading to high ARFI values (Janssen et al, 2007;Park et al, 2014).…”

Section: Primary Applications Of Elastographymentioning

confidence: 99%

Elastography: Principles and considerations for clinical research in veterinary medicine cibele

Figueira¹,

Thassila²,

Maria³

2015

J. Vet. Med. Anim. Health

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Since the beginning of medicine, palpation has been the primary semiologic method used to detect abnormalities during clinical examination. The mechanical properties of soft tissues are usually related to changes in stiffness. However, changes in stiffness and echogenicity of soft tissues are not always correlated. Elastography has emerged in the last decade as a new method that, when used in association with ultrasonography, can provide information about the acoustic properties (echogenicity and texture) and mechanical attributes (stiffness) of a region of interest in a specific tissue. The objective of this article is to review the literature on the physical principles of elastography and to describe several features of the elastographic imaging process to provide a better understanding of this new technique and its potential utilization in the veterinary field.

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EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions

Cited by 255 publications

References 23 publications

Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses: Pancreatic cancer vs. inflammatory mass in chronic pancreatitis

Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses: Pancreatic cancer vs. inflammatory mass in chronic pancreatitis

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study

Elastography: Principles and considerations for clinical research in veterinary medicine cibele

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