Intraoperative Characterization of Pancreatic Tumors Using Contrast‐Enhanced Ultrasound and Shear Wave Elastography for Optimization of Surgical Strategies

Abstract

Objectives-To evaluate intraoperative contrast-enhanced ultrasound (IoCEUS) and intraoperative shear wave elastography (IoSWE) for characterization of focal pancreatic lesions (FPLs) in correlation with postoperative histologic results. Thereby, the impact of intraoperative ultrasound (US) on pancreas surgery was evaluated.Methods-Intraoperative CEUS and SWE data from 54 patients, who underwent pancreas surgery between 2017 and 2019, were analyzed retrospectively. Ultrasound examinations were performed with multifrequency linear/T-shaped transducers (3-9 MHz) on a high-end US device (LOGIQ E9; GE Healthcare, Chicago, IL). To analyze FPL stiffness by SWE, regions of interest were placed to measure the shear wave speed (meters per second) and stiffness (kilopascals). After intravenous bolus injections of 2.4 to 10 mL of sulfur hexafluoride microbubbles, a dynamic analysis of FPL microvascularization from arterial to late phases was performed using IoCEUS considering hypoenhancement/irregular vascularization of macrocystic/small solid FPL malignancy criteria. Ultrasound findings were correlated with postoperative histologic results. The impact of intraoperative US on surgery was documented in each case.Results-Of 54 FPLs, IoCEUS could correctly characterize 39 of 39 malignant and 6 of 15 benign FPLs; IoSWE 29 of 39 as malignant and 7 of 15 as benign. Intraoperative CEUS's sensitivity was 100%; specificity, 40%; accuracy, 83.3%; positive predictive value, 81.3%; and negative predictive value, 100% (P < .05). Applying cutoff values of 3 m/s and 28.7 kPa, SWE's sensitivity was 74.4%; specificity, 46.7%; accuracy, 66.7%; positive predictive value; 78.4%; and negative predictive value, 41.2% for cancer detection (P < .05). The combined use of both techniques showed an accuracy rate of 76%, sensitivity of 74.4%, and specificity of 33.3%. In 29.6%, US results had an immediate impact on surgery.Conclusions-Intraoperative SWE and CEUS are highly valuable techniques for intraoperative characterization of FPLs. Although IoCEUS proved to be superior to IoSWE, the combined use can be helpful in particular cases.

Contrast‐enhanced Ultrasound Combined With Elastography for the Evaluation of Muscle‐invasive Bladder Cancer in Rats

“…Previous studies reported good diagnostic performances of CEUS and SWE for intestinal, 46 thyroid, 47 and pancreatic 48 lesions. Some studies reported that the combined use of CEUS and micro‐flow imaging improved the diagnostic performance for breast tumors 49 .…”

Mind the tributary of the canal: Are stents necessary for insulinoma enucleation in proximity to a prominent Duct of Santorini: A case report and literature review

“…[17,18] Despite the current controversial conclusions, auxiliary measures such as intraoperative ultrasonography are helpful and sometimes mandatory to explore the exact spatial relationship between the tumor and the duct before determining the type of surgery, especially in cases where the tumor-duct distance is small or indeterminate based on pre-operative imaging data. [19,20] In this case, a 49-year-old female patient was diagnosed with functional pancreatic insulinoma, with no special symptoms, manifestations, comorbidities and chronic conditions. Base on the preoperative imaging data, the tumor was benign was far away from the MPD (>3 cm) and a stent at the MPD was not placed.…”

“…[ 17 , 18 ] Despite the current controversial conclusions, auxiliary measures such as intraoperative ultrasonography are helpful and sometimes mandatory to explore the exact spatial relationship between the tumor and the duct before determining the type of surgery, especially in cases where the tumor-duct distance is small or indeterminate based on pre-operative imaging data. [ 19 , 20 ]…”

Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons

“…Future studies involving HRUS could investigate facial muscles changes occurring postoperatively, as well as following conservative management. US applying 3D technology or a volumetric assessment may reveal intramuscular changes associated with different (non-)surgical procedures [ 66 ]. Further studies are needed to determine how US morphologic and functional findings, such as (facial) muscle size and dynamic muscular behavior, correlate with clinical conditions like muscular hypertonicity.…”