1. Clinical impact of strain histogram EUS elastography and contrast-enhanced EUS for the differential diagnosis of focal pancreatic masses: A prospective multicentric study
- Author
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Julio Iglesias Garcia, Adrian Saftoiu, Sun Siyu, Alina Constantin, Mădălin Ionuţ Costache, Erwin Santo, Manoop S. Bhutani, Maria Chiara Petrone, Carmen Popescu, Paolo Giorgio Arcidiacono, Marc Giovannini, Erwan Bories, Christoph F. Dietrich, Irina M. Cazacu, Costache, M. I., Cazacu, I. M., Dietrich, C. F., Petrone, M. C., Arcidiacono, P. G., Giovannini, M., Bories, E., Garcia, J. I., Siyu, S., Santo, E. F., Popescu, C., Constantin, A., Bhutani, M. S., and Saftoiu, A.
- Subjects
medicine.medical_specialty ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,strain histogram elastography ,contrast-enhanced harmonic imaging ,Pancreatic cancer ,Chronic pseudotumoral pancreatitis ,medicine ,pancreatic adenocarcinoma ,Cutoff ,Radiology, Nuclear Medicine and imaging ,Medical diagnosis ,EUS ,pancreatic neuroendocrine tumors ,Hepatology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Gastroenterology ,Gold standard (test) ,medicine.disease ,digestive system diseases ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Original Article ,Radiology ,Elastography ,Differential diagnosis ,business - Abstract
Background: Recent advances in EUS techniques (real-time EUS elastography and contrast-enhanced EUS) have allowed a better characterization of focal pancreatic masses. Mean strain histograms (SHs) are considered a good parameter for the semi-quantitative evaluation of focal pancreatic masses, alongside complementary contrast-enhanced EUS parameters which can be quantified during both the early arterial and late venous phase. Materials and Methods: The study design was prospective, blinded, and multicentric, assessing real-time EUS elastography and contrast-enhanced EUS results for the characterization of focal pancreatic masses using parametric measurements, in comparison with pathology which is the gold standard. SHs were performed based on the embedded software of the ultrasound system, with the values being reversed as opposed to our initially published data on hue histograms. Consequently, a cutoff of 80 was derived from previous multicentric trials. Contrast-enhanced EUS also allowed the focal masses to be classified as hyper-, iso-, or hypoenhanced in comparison with the normal pancreatic parenchyma. EUS-FNA was then performed for all patients, with a positive cytological diagnosis taken as a final proof of malignancy for the pancreatic masses. The diagnoses obtained by EUS-FNA were verified further either by surgery or during a clinical follow-up of at least 6 months. Results: A total number of 97 consecutive patients with focal pancreatic masses were included in the study. Based on previously defined cutoffs of 80, the values of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the mean SHs for the diagnosis of pancreatic cancer were 100%, 29.63%, 78.65%, 100%, and 80.41%, respectively. Corresponding values for contrast-enhanced EUS (taking into consideration hypoenhencement as a predictive factor of malignancy) were 98.57%, 77.78%, 92%, 95.45%, and 92.78%, respectively. Combining contrast enhancement-EUS (hypoenhencement) and semi-quantitative EUS elastography (SH cutoffs
- Published
- 2020