Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions

Hirche, Tim O.; Ignee, A.; Barreiros, Ana Paula; Schreiber-Dietrich, Dagmar; Jungblut, Sven; Ott, Michaela; Hirche, H.; Dietrich, C. F.

doi:10.1055/s-2008-1077726

Cited by 155 publications

(116 citation statements)

References 19 publications

(31 reference statements)

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“…Authors could only complete the elastographic evaluation in 56% of patients, mainly related to the difficulty of delimiting the region of interest in tumors greater than 35 mm, or in those far away from the transducer, as they could not include enough surrounding tissue for control purposes. They obtained a diagnostic sensitivity of 41% and a specificity of 53% with an overall accuracy of 45%, clearly worse than in previous studies (23). However, it is important to point out that all 58 tumors included in the study were malignant, without a single benign lesion.…”

Section: Discussionmentioning

confidence: 56%

“…Another advance in this setting is worth mentioning. Saftoiu et al (23) have recently published their results with a novel method based on a specially designed software, which allows a quantitative analysis by calculating hue histograms for each individual elastographic image. They included 22 normal pancreas controls, 11 patients with chronic pancreatitis, 32 pancreatic adenocarcinomas, and 3 neuroendocrine tumors.…”

Section: Discussionmentioning

confidence: 99%

“…En esta misma línea, un estudio reciente que incluye 70 pacientes con lesiones sólidas pancreáticas y 10 controles sanos, los autores sólo pudieron completar el estudio elastográfico en el 56% de los pacientes, fundamentalmente por la dificultad de delimitar en la región de estudio lesiones mayores de 35 mm o en aquellas alejadas del transductor, al no poder incluir en la región de estudio suficiente tejido normal de control. Obtuvieron una sensibilidad diagnóstica del 41%, una especificidad del 53% y una eficacia global del 45%, cifras claramente inferiores a la de los estudios previos (23). Sin embargo, en este estudio es criticable el hecho de las 58 lesiones sólidas incluidas en el estudio eran tumores malignos, sin incluir ninguna lesión benigna.…”

Section: Casounclassified

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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: 56%

Section: Discussionmentioning

confidence: 99%

Section: Casounclassified

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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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“…Hirsche i wsp. [18] zwrócili uwagę na wiele trudności technicznych związanych z badaniem elastograficznym przeprowadzanym w trakcie badania endoskopowego. Próbowali oni dokonać elastograficznej oceny zmian w trzustce u 70 pacjentów i 10 zdrowych ochotników.…”

Section: Elastografia Chorób Trzustkiunclassified

Endoscopic ultrasound elastography in digestive tract diseases

Motkowska¹,

Romatowski²,

Januszko³

et al. 2012

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S Sł ło ow wa a k kl lu uc cz zo ow we e: : ultrasonografia endoskopowa, elastografia, trzustka, węzły chłonne. K Ke ey y w wo or rd ds s: : endoscopic ultrasound, elastography, pancreas, lymph nodes. StreszczenieBadania obrazowe, takie jak ultrasonografia, tomografia komputerowa czy tomografia rezonansu magnetycznego, umożli-wiają wykrycie zmian chorobowych niedostępnych badaniem palpacyjnym. Wymienione techniki nie umożliwiają jednak oceny właściwości mechanicznych badanych tkanek, takich jak twardość czy sztywność. Założenie, że powyższe cechy tkanki zmienionej chorobowo różnią się od tkanki prawidło-wej oraz odkształca się ona inaczej pod wpływem fal ultradźwiękowych, jest podstawą elastografii ultrasonograficznej. Miniaturyzacja sprzętu oraz rozwój techniki ultrasonograficznej i endoskopowej umożliwiły zastosowanie w praktyce klinicznej połączenia obu tych metod. Dodatkowych informacji może dostarczać wykonywana w trakcie endoskopowego badania ultrasonograficznego elastografia. W niniejszej pracy przedstawiono przegląd piśmiennictwa dotyczącego doświad-czeń z wykorzystaniem endoskopowej elastografii ultrasonograficznej w diagnostyce schorzeń przewodu pokarmowego. Opublikowane doniesienia dotyczą badania trzustki, węzłów chłonnych położonych w sąsiedztwie przewodu pokarmowego (głównie w śródpiersiu) oraz zmian w okolicy zwieracza odbytu. Badanie elastograficzne wykonywane konwencjonalnie przez powłoki brzuszne jest wykorzystywane także w diagnostyce włóknienia wątroby. Abstract

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“…New EUS-related technologies such as contrast media and elastography have also improved PNET localization (16)(17)(18)(19)(20)(21)(22) with percentages matching those obtained with EUS-FNA.…”

Section: Introductionmentioning

confidence: 99%