Interobserver Reliability of the Endoscopic Ultrasound Criteria for the Diagnosis of Early Chronic Pancreatitis: Comparison between the 2009 and 2019 Japanese Diagnostic Criteria

Yamamiya, Akira; Irisawa, Atsushi; Tominaga, Keiichi; Tsuchida, Kenji; Sugaya, Takeshi; Tsunemi, Misako; Hoshi, Koki; Jinnai, Hidehito; Yamabe, Akane; Izawa, Naoya; Iwasaki, Mari; Takimoto, Yoichi; Kanamori, Akira; Nagashima, Kazunori; Minaguchi, Takahito; Kashima, Ken; Kunogi, Yasuhito; Sato, Ai; Goda, Kenichi; Iijima, Makoto; Haruyama, Yasuo

doi:10.3390/diagnostics11030431

Cited by 11 publications

(12 citation statements)

References 33 publications

(16 reference statements)

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“…3 This revision resulted in a higher IOR than that obtained when using DC2009. 21 However, no further reports are yet available. Our study confirmed the validity of this criterion by demonstrating a high IOR for EUS findings (κ = 0.74 for hyperechoic foci/stranding; κ = 0.66 for lobularity) and the correlation between EUS findings and histological features.…”

Section: Endoscopic Ultrasonography and Histologymentioning

confidence: 99%

Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis

Inomata

Masuda

Yamakawa

et al. 2022

J of Gastro and Hepatol

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Background and Aim Endoscopic ultrasonography (EUS) findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, may be associated with the severity of chronic pancreatitis (CP). However, the correlation between parenchymal EUS findings and histology remains unclear. We designed a large‐scale retrospective study analyzing over 200 surgical specimens to elucidate the association between parenchymal EUS findings and histological features. Methods Clinical data of 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery between January 2010 and November 2020 were reviewed to investigate the association between parenchymal EUS findings and histological features at the pancreatic body. None of these patients met the definition of CP. Results Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2–7.9] vs 31.3 [9.3–105.6], Ptrend < 0.001; 3.9 [1.9–8.2] vs 21.8 [8.0–59.4], Ptrend < 0.001; and 4.0 [2.0–7.8] vs 22.9 [7.0–74.5], Ptrend < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. Conclusions Endoscopic ultrasonography findings of the pancreatic parenchyma may be associated with the histological conditions in CP, such as pancreatic fibrosis, inflammation, and atrophy. Lobularity reflects more severe histological conditions than does hyperechoic foci/stranding.

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Section: Endoscopic Ultrasonography and Histologymentioning

confidence: 99%

Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis

Inomata

Masuda

Yamakawa

et al. 2022

J of Gastro and Hepatol

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“…First, the trans-abdomen shear wave elastography is interfered by central obesity, exemplified by a case in the current study and who eventually underwent EUS to diagnose early chronic pancreatitis. Second, EUS is an invasive procedure with inter-observer variability, showing a kappa value (level of agreement) of about 0.6–0.8 [ 15 , 18 , 49 ]. The optimal resolution is probably the EUS technique combined with shear wave measurement, which objectively and quantitatively assesses the stiffness of pancreatic parenchyma [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Fibrosis (Early Chronic Pancreatitis) as Emerging Diagnosis in Structural Causes of Dyspepsia: Evidence from Endoscopic Ultrasonography and Shear Wave Elastography

et al. 2021

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A new concept for the diagnosis and management of non-functional dyspepsia in guidelines was lacking in the past decade. Medical advancement has proven pancreatic fibrosis (essential image evidence of early chronic pancreatitis) to be a cause of dyspepsia and related to pancreatic exocrine dysfunction. This study aimed to analyze the clinical picture, biomarker, and percentage of pancreatic fibrosis in the dyspeptic population. A total of 141 consecutive patients were retrospectively enrolled. They were diagnosed with peptic ulcer disease, 9.2% (n = 13); pancreatic fibrosis, 17% (n = 24); pure Helicobacter pylori infection, 19.9% (n = 28); functional dyspepsia, 53.2% (n = 75); and chronic pancreatitis, 0.7% (n = 1). Among those with pancreatic fibrosis, (n = 24), 11 were diagnosed on the basis of a pancreatic acoustic radiation force impulse exceeding 1.4 m/s, and the remaining 13 were diagnosed with early chronic pancreatitis with at least three of the Japanese endoscopic ultrasonography criteria. The anatomic distribution of parenchymal criteria of early chronic pancreatitis was head, 53%; body, 38%; and tail, 9%. There were 17 cases (71%, 17/24) without Helicobacter pylori and whose dyspepsia improved after pancreatic enzyme replacement with a ratio of 82.3% (14/17). Of the 141 cases, 19 received gastric emptying scintigraphy and Western blot analysis of chromogranin-A in duodenal mucosa. Delayed gastric emptying was more common in functional dyspepsia and chromogranin-A was expressed more in pancreatic fibrosis. In conclusion, pancreatic fibrosis (including early chronic pancreatitis) outnumbered peptic ulcer disease in the dyspeptic population and pancreatic enzyme therapy was effective for 82% of cases. In early chronic pancreatitis, pancreatic fibrosis is dominant in the head location, and duodenum mucosa chromogranin-A is a potential biomarker with increased expression in an age-matched manner.

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“…We analyzed the changes in EUS findings with DCECP2019 and examined the validity of the revision. 31 The overall concordance rate of EUS findings in the old criteria in 2009 (DCECP2009) was K ‐value = 0.424, and the overall diagnostic concordance rate of EUS findings in DCECP 2019 was K‐ value = 0.618. DCECP2019 combines EUS findings that were similar to DCECP2009.…”

Section: Comparison Of Eus Findings With Histopathological Findingsmentioning

confidence: 95%

“…Some reports have compared the diagnostic performance of conventional methods with that of the Rosemont classification, but no significant differences in the correct diagnosis rates are clear, partly because of interobserver reliability (IOR) and the complexity of the Rosemont classification. 24 , 25 , 26 , 27 , 30 , 31 …”

Section: Diagnosis Of Cp Using Eusmentioning

confidence: 99%

Diagnosing chronic pancreatitis by endoscopic ultrasound assessing the association between ultrasound and pathological findings: A narrative review

et al. 2022

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Endoscopic ultrasound (EUS) is widely recognized for its non‐invasiveness and for its usefulness in chronic pancreatitis (CP) diagnosis, including early CP. Although it is desirable to obtain a definitive diagnosis of CP by tissue sampling with EUS‐guided fine needle aspiration, histopathological changes in CP are heterogeneous in terms of the extent and the distribution of lesions. Therefore, histopathological diagnosis of appropriate tissue sampling by EUS‐fine needle aspiration is expected to be difficult. Furthermore, it is virtually impossible to match EUS images with pathological sections, making direct contrast between EUS findings and pathology difficult. This narrative review presents a discussion of the diagnosis of CP/early CP by EUS, particularly assessing the association between ultrasound and pathological findings. Recently, the histological corroboration and correlation of EUS findings related to CP have been clarified by surgical specimens, including those obtained from animal studies. Furthermore, remarkable advances have occurred in the objective and quantitative diagnosis of pancreatic fibrosis by EUS‐elastography. Future technological advances in EUS are expected to improve the accuracy of diagnosis of pancreatic fibrosis at earlier stages.

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Interobserver Reliability of the Endoscopic Ultrasound Criteria for the Diagnosis of Early Chronic Pancreatitis: Comparison between the 2009 and 2019 Japanese Diagnostic Criteria

Cited by 11 publications

References 33 publications

Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis

Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis

Pancreatic Fibrosis (Early Chronic Pancreatitis) as Emerging Diagnosis in Structural Causes of Dyspepsia: Evidence from Endoscopic Ultrasonography and Shear Wave Elastography

Diagnosing chronic pancreatitis by endoscopic ultrasound assessing the association between ultrasound and pathological findings: A narrative review

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