Yield of contrast-enhanced power doppler endoscopic ultrasonography and strain ratio obtained by eus-elastography in the diagnosis of focal pancreatic solid lesions

Figueiredo, FátimaA.F; Monges, Geneviève; Pesenti, Christian; Delpero, Jean Robert; Giovannini, Marc; Silva, PatriciaM da; Bories, Erwan; Caillol, Fabrice

doi:10.4103/2303-9027.117734

Cited by 26 publications

(18 citation statements)

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“…34 In contrast, another study on 38 patients reported a hypo-enhanced appearance to be the only variable predictive of malignancy in focal pancreatic solid lesions. 35 The hypo-enhanced inhomogeneous pattern was seen more frequently in patients with chronic pancreatitis (6/12), but was also seen in patients with adenocarcinoma (4/15). These findings were confirmed in other reports.…”

Section: The Differential Diagnosis Between Mass-forming Pancreatitismentioning

confidence: 96%

Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions

Shim

Lee

Cheon

2016

Int J Gastrointest Interv

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Accurate diagnosis of pancreatic solid lesions is often difficult using conventional imaging modalities. With the recent introduction of contrastenhanced harmonic endoscopic ultrasound (CEH-EUS), it is now possible to evaluate the microvascular environment and dynamic enhancement of a variety of pancreatic lesions. With CEH-EUS, three patterns of pancreatic lesion enhancement compared with the normal pancreatic tissue (fast, simultaneous, or slow), two washout patterns (fast or slow) and two distribution patterns (homogeneous, inhomogeneous) can be described. By evaluating the microvasculature, enhancement speed, and washout pattern, CEH-EUS may help to differentiate pancreatic adenocarcinoma from other masses and differentiate between pancreatic neuroendocrine tumor (pNET) and inflammatory masses. The finding of a hyperenhancing lesion on CEH-EUS, both with homogeneous and inhomogeneous patterns, was a strong predictor of histology different from adenocarcinoma (94% positive predictive value). pNET was the most common hyperenhancing lesions overall. Although CEH-EUS is useful for ruling out pancreatic ductal adenocarcinoma, making the differential diagnosis between pNETs and pseudotumoral pancreatic masses is difficult because both may share an isovascular or hypervascular appearance. Currently the interpretation of CEH-EUS findings is examiner-dependent. In the future, digital image analysis by image-processing techniques should allow more objective interpretation.

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Section: The Differential Diagnosis Between Mass-forming Pancreatitismentioning

confidence: 96%

Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions

Shim

Lee

Cheon

2016

Int J Gastrointest Interv

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“…Various studies have explored the potential of EUS-E in differentiating between benign and malignant lesions and have yielded encouraging results. [6][7][8][9][10] Despite these encouraging results, EUS-E is currently not ready to replace EUS FNA/B because of false positives and false negatives. Hence, there have been numerous attempts to improve on the specificity of EUS-E like the use of quantitative EUS-E or addition of software-based evaluation of EUS-E images like fractal analysis.…”

Section: Commentarymentioning

confidence: 99%

“…Different studies have defined the different cut-off levels of SR with sensitivities varying from 67% to 98% and specificities between 45% and 71%. [10][11][12] Meta-analyses of studies evaluating EUS-E for pancreatic lesions have shown the sensitivity of 95% and specificity of 67%-69% for differentiating benign versus malignant SPLs. [13,14] In this news and views, we discuss two interesting studies that have further evaluated the role of EUS-E in SPLs.…”

mentioning

confidence: 99%

Endoscopic Ultrasound Elastography for Solid Pancreatic Lesions: Ready to Replace Fine‑needle Biopsy?

Agarwala

Rana

2018

Journal of Digestive Endoscopy

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“…17 However, a direct comparison between elastography and CEH-EUS has only been made in one small study to date and there is little information on how the results of both techniques can be combined in the differential diagnosis of solid pancreatic masses. 18…”

Section: Introductionmentioning

confidence: 99%

Differential diagnosis of solid pancreatic masses: contrast‐enhanced harmonic (CEH‐EUS), quantitative‐elastography (QE‐EUS), or both?

et al. 2017

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Background: Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Methods: Sixty-two consecutive patients (mean age 64.3 years, range 32-89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Results: Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n ¼ 45), neuroendocrine tumor (n ¼ 3), inflammatory mass (n ¼ 10), pancreatic metastasis (n ¼ 2), autoimmune pancreatitis (n ¼ 1), and a mucinous cystadenocarcinoma (n ¼ 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4-99.7), 85.5% (95% CI: 74.7-92.2), 91.9% (95% CI: 82.5-96.5), and 91.5% (95% CI: 83.6-99.5), respectively. Conclusion: The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

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Yield of contrast-enhanced power doppler endoscopic ultrasonography and strain ratio obtained by eus-elastography in the diagnosis of focal pancreatic solid lesions

Cited by 26 publications

References 0 publications

Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions

Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions

Endoscopic Ultrasound Elastography for Solid Pancreatic Lesions: Ready to Replace Fine‑needle Biopsy?

Differential diagnosis of solid pancreatic masses: contrast‐enhanced harmonic (CEH‐EUS), quantitative‐elastography (QE‐EUS), or both?

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