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Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 116-121

Clinical impact of strain histogram EUS elastography and contrast-enhanced EUS for the differential diagnosis of focal pancreatic masses: A prospective multicentric study

1 Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
2 Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania; Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA
3 Medical Department, Caritas Krankenhaus Bad Mergentheim, Main-Tauber-Kreis, Germany
4 Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
5 Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
6 Gastroenterology Unit, University Hospital, Santiago De Compostella, Spain
7 Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang, China
8 Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
9 Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy; Department of Pathology, Cytology Laboratory, County Emergency Clinical Hospital, Craiova, Romania
10 Department of Gastroenterology, Ponderas Academic Hospital, Bucharest, Romania
11 Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA

Correspondence Address:
Dr. Adrian Saftoiu
Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_69_19

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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 <80), the resulting values corresponding for sensitivity, specificity, and accuracy were 98.57%, 81.48%, and 93.81%, respectively. Conclusion: The current study using objective parametric tools for both EUS elastography and contrast-enhanced EUS confirmed the results of previous studies and meta-analyses that indicated a complementary role for the differential diagnosis of focal pancreatic masses. Moreover, the best values for the receiver operating curves were obtained using a sequential clinical algorithm based on the initial use of elastography, followed by contrast enhancement.

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