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. 2018 Jul-Aug;31(4):513-518.
doi: 10.20524/aog.2018.0271. Epub 2018 May 7.

Diagnostic accuracy of fine-needle aspiration of solid pancreatic lesions guided by endoscopic ultrasound elastography

Antonio Facciorusso  1 , Matteo Martina  1 , Rosario Vincenzo Buccino  1 , Maurizio Cosimo Nacchiero  1 , Nicola Muscatiello  1
Affiliations

Diagnostic accuracy of fine-needle aspiration of solid pancreatic lesions guided by endoscopic ultrasound elastography

Antonio Facciorusso et al. Ann Gastroenterol. 2018 Jul-Aug.

Abstract

Background: Real-time elastography (RTE) may increase the diagnostic accuracy of fine-needle aspiration guided by endoscopic ultrasound. The aim of this study was to establish the diagnostic accuracy, sensitivity, and specificity of this combined methodological approach in a cohort of patients with solid pancreatic masses.

Methods: We reviewed data from 54 patients with solid pancreatic lesions referred to our institution between January 2014 and June 2015. RTE, assessed in terms of strain ratio, was performed both qualitatively and semi-quantitatively, and a 25G needle was inserted into the most suspicious part of the lesion. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values were calculated.

Results: The median lesion size was 35 mm (interquartile range: 25-43 mm). A diagnosis of adenocarcinoma was confirmed in 85.1% of cases. RTE, with a strain ratio cutoff of 4.21, showed a sensitivity of 86.9%, a specificity of 75%, and diagnostic accuracy of 85.1%. The diagnostic accuracy, sensitivity, and specificity of the combined methodology were 94.4%, 93.4%, and 100%, respectively. The positive predictive value was 100%, the negative predictive value 72.7% and the negative likelihood ratio 6.5. No severe adverse events were registered.

Conclusion: The combination of RTE with endoscopic ultrasound-guided fine-needle aspiration appears to be an efficient and safe technique for the characterization of solid pancreatic masses.

Keywords: Real-time elastography; endoscopic ultrasound; pancreatic cancer; sensitivity.

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Figures

Figure 1
Figure 1
An endoscopic ultrasonography image describing real-time elastography-targeted fine-needle aspiration of a solid lesion located in the pancreatic head. The needle was inserted into the most suspicious part (“dark blue”) of the lesion. The final diagnosis identified ductal adenocarcinoma
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve analysis aimed at identifying the best cutoff point for elastography strain ratio. ROC curve analysis identified the value 4.21 as the most sensitive and specific cutoff point for the elastography strain ratio
See this image and copyright information in PMC

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