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. 2015 Mar 20;10(3):e0121236.
doi: 10.1371/journal.pone.0121236. eCollection 2015.

Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study

Xiaojia Hou  1 , Zhendong Jin  1 , Can Xu  1 , Minmin Zhang  1 , Jianwei Zhu  1 , Fei Jiang  1 , Zhaoshen Li  1
Affiliations

Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study

Xiaojia Hou et al. PLoS One. .

Abstract

Background: The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis.

Aims: To evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions.

Methods: Patients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups.

Results: Operating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%).

Conclusion: Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Representative example of a pancreatic adenocarcinoma with hypoenhancement.
Conventional endoscopic ultrasonography (left) shows a heterogeneous hypoechoic area without a clear margin at the pancreas head. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that most of the area is hypovascular and the remaining area is hypervascular compared to the surrounding tissue. An irregular margin is visible.
Fig 2
Fig 2. Representative example of focal pancreatitis with hyperenhancement.
Conventional endoscopic ultrasonography (left) shows a slightly hypoechoic area without a clear margin at the pancreas head. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that enhancement in this area is higher than in the surrounding tissue, and a margin is clearly visible.
Fig 3
Fig 3. Representative example of a pancreatic neuroendocrine tumor with hyperenhancement.
Conventional endoscopic ultrasonography (left) shows a hypoechoic mass with a clear margin at the pancreas body. Contrast-enhanced harmonic endoscopic ultrasonography (right) indicates that the mass has a hyperenhancement compared to the surrounding tissue.
See this image and copyright information in PMC

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