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. 2012 Oct;1(3):143-9.
doi: 10.7178/eus.03.005.

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

Fátima A F Figueiredo  1 , Patricia M da Silva  1 , Genevieve Monges  2 , Erwan Bories  3 , Christian Pesenti  3 , Fabrice Caillol  3 , Jean R Delpero  4 , Marc Giovannini  3
Affiliations

Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions

Fátima A F Figueiredo et al. Endosc Ultrasound. 2012 Oct.

Abstract

Objective: Although endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the gold standard for diagnosing pancreatic lesions, its negative predictive value is suboptimal. Our aim was to evaluate the yield of contrast-enhanced EUS (CED-EUS) and of strain ratio EUS-elastography (SR-E-EUS) for differentiating pancreatic solid lesions.

Methods: Forty-seven patients (27 men, 20 women, 70 ± 11 years) were consecutively involved in this single-center, prospective study. They were submitted to EUS, SR-E-EUS, CED-EUS with Sonovue(®), and EUS-FNA. The final diagnosis was based on the histological assessment of EUS-FNA and/or surgical specimens when available, and on follow-up of at least 6 months.

Results: From the 47 focal pancreatic lesions included, 13 (28%) were benign and 34 (72%) malignant. Patients with malignancy were older (70 ± 11 vs. 61 ± 8, P = 0.003), and had larger lesions (34 ± 12 mm vs. 22 ± 11 mm, P = 0.03). Malignant lesions had higher SR-E-EUS (31 ± 32 vs. 8 ± 9, P = 0.001) and more hypovascular pattern (93% vs. 33%, P < 0.001). Logistic regression determined that only hypovascularity (OR = 2.6, 95%CI: 1.5-130, P = 0.02) was independently predictive of malignancy. ROC analysis for SR-E-EUS yielded an optimal cutoff of 8 (AUC 0.91, 95%CI: 0.74-0.98) for the best power distinction for malignancy. There was no significant difference concerning sensitivity (79%, 90%, 93%) and specificity rates (85%, 75%, 67%) of EUS-FNA, SR-E-EUS, and CED-EUS, respectively. By analysis of the inconclusive EUS-FNA subset (9 patients, 19%), SR-E-EUS > 8 and hypovascularity showed sensitivity of 80% and 100%, and specificity of 67% and 67%, respectively.

Conclusion: The clinical utility of CED-EUS and SR-E-EUS remains questionable. The accuracies of CED-EUS and SR-E-EUS are similar to EUS-FNA. Hypovascularity was independently predictive of malignancy. Patients with inconclusive EUS-FNA could benefit from CED-EUS due to the high sensitivity of hypovascularity for diagnosing malignancy.

Keywords: contrast enhanced ultrasound; elastography; endoscopic ultrasound; endosonography; fine needle aspiration; pancreatic neoplasms.

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Figures

Figure 1
Figure 1
Elastographic and B-mode images are displayed simultaneously side by side. A circular area was adjusted to the focal lesion and a second one was adjusted to the surrounding tissue. The strain ratio of 42.6 was calculated in this case of pancreatic cancer.
Figure 2
Figure 2
A strain ratio of 1 was calculated in this case of chronic pancreatitis.
Figure 3
Figure 3
Hypovascular pattern in pancreatic cancer mass examined with power Doppler after contrast injection. The pattern of enhancement pattern was defined by observing for over 3 min.
Figure 4
Figure 4
Hypervascular pattern in chronic pancreatitis examined with power Doppler after contrast injection.
Figure 5
Figure 5
The receiver operating characteristic (ROC) curve of the mean strain ratio obtained by endoscopic ultrasonography-elastography of the region of interest used for the discrimination between benign and malignant lesions (sensitivity of 90% and specificity of 75% for a cutoff value of 8). The area under the ROC curve was 0.91.
See this image and copyright information in PMC

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