Utility of contrast‐enhanced harmonic endoscopic ultrasonography for predicting the prognosis of pancreatic neuroendocrine neoplasms

Abstract

Background and Aims Pancreatic neuroendocrine neoplasms (PanNENs), including Grade 1 (G1) or G2 tumors, can have a poor prognosis. This study investigated the value of contrast‐enhanced harmonic endoscopic ultrasonography (CH‐EUS) for predicting the prognosis of PanNENs. Methods This single‐center, retrospective study included 47 consecutive patients who underwent CH‐EUS and were diagnosed with PanNEN by surgical resection or EUS‐guided fine needle aspiration between December 2011 and February 2016. Patients were divided into aggressive and non‐aggressive groups according to the degree of clinical malignancy. CH‐EUS was assessed regarding its capacity for diagnosing aggressive PanNEN, the correspondence between contrast patterns and pathological features, and its ability to predict the prognosis of PanNEN. Results There were 19 cases of aggressive PanNEN and 28 cases of non‐aggressive PanNEN. The aggressive group included three G1, four G2, three G3 tumors, three mixed neuroendocrine non‐neuroendocrine neoplasms, and six neuroendocrine carcinomas. CH‐EUS was superior to contrast‐enhanced computed tomography for the diagnosis of aggressive PanNEN (P < 0.001): hypo‐enhancement on CH‐EUS was an indicator of aggressive PanNEN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94.7%, 100%, 100%, 96.6%, and 97.9%, respectively. Among G1/G2 PanNENs, cases with hypo‐enhancement on CH‐EUS had a poorer prognosis than those with hyper/iso‐enhancement (P = 0.0009). Assessment of 36 resected specimens showed that hypo‐enhancement on CH‐EUS was associated with smaller and fewer vessels and greater degree of fibrosis. Conclusion Contrast‐enhanced harmonic endoscopic ultrasonography may be useful for predicting the prognosis of PanNENs.

Automatic Segmentation of Pancreatic Tumors Using Deep Learning on a Video Image of Contrast-Enhanced Endoscopic Ultrasound

“…Contrast-enhanced EUS (CE-EUS) is one technique of image enhanced EUS. CE-EUS is a novel imaging modality that detects signals from microbubbles in vessels and allows evaluation of real-time perfusion and microvasculature of pancreatic tumors [16,[18][19][20][21][22]. The diagnostic sensitivity and specificity for pancreatic ductal carcinoma by qualitative evaluation of enhancement pattern during CE-EUS were reported as 95.1% (95% confidence interval (CI) 92.7-96.7%) and 89.0% (95% CI 83.0-93.1%), respectively [23].…”

Contrast‐enhanced harmonic endoscopic ultrasonography: Additional tool to predict clinical behavior of pancreatic neuroendocrine neoplasms

“…Peutz-Jeghers syndrome (PJS) is a rare disease, known to place affected individuals at high risk for the development of gastrointestinal cancer. 1 Careful surveillance and early detection of gastrointestinal neoplasms in these patients are, therefore, mandatory. However, the mechanism by which gastrointestinal neoplasms develop in PJS patients remains controversial.…”

“…Contrast‐enhanced harmonic EUS (CH‐EUS) has achieved large interest in the detection and characterization of pancreatic neoplasms. We read the manuscript by Ishikawa et al about CH‐EUS in the evaluation of pancreatic neuroendocrine neoplasms (PanNENs) 1 . They enrolled 47 patients with newly‐diagnosed PanNENs, comparing CH‐EUS to computed tomography (CT) and histology.…”

Paradigm shift in image‐enhanced endoscopic ultrasonography

“…compared the imaging pattern of CH‐EUS for PanNEN with the WHO 2017 classification criteria and clinical aggressiveness. This study included 47 PanNENs (36 resected cases) 10 . Tumor aggressiveness was defined by the presence of tumor infiltration into the surrounding pancreatic parenchyma and the development of distant metastasis.…”

“…This study included 47 PanNENs (36 resected cases). 10 Tumor aggressiveness was defined by the presence of tumor infiltration into the surrounding pancreatic parenchyma and the development of distant metastasis. The aggressive group included three G1 lesions, four G2 lesions, three G3 lesions, and three cases of mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN).…”