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. 2022 Sep-Oct;11(5):401-406.
doi: 10.4103/EUS-D-21-00185.

Utility of contrast-enhanced harmonic EUS for diagnosis of portal vein invasion by pancreatic cancer

Atsushi Nakai  1 , Ken Kamata  1 , Tomoko Hyodo  2 , Takaaki Chikugo  3 , Akane Hara  1 , Yasuo Otsuka  1 , Hidekazu Tanaka  1 , Tomoe Yoshikawa  1 , Rei Ishikawa  1 , Ayana Okamoto  1 , Tomohiro Yamazaki  1 , Shunsuke Omoto  1 , Kosuke Minaga  1 , Kentaro Yamao  1 , Mamoru Takenaka  1 , Yasutaka Chiba  4 , Tomohiro Watanabe  1 , Ippei Matsumoto  5 , Yoshifumi Takeyama  5 , Masatoshi Kudo  1
Affiliations

Utility of contrast-enhanced harmonic EUS for diagnosis of portal vein invasion by pancreatic cancer

Atsushi Nakai et al. Endosc Ultrasound. 2022 Sep-Oct.

Abstract

Background: The value of contrast-enhanced harmonic EUS (CH-EUS) for diagnosis of portal vein invasion in patients with pancreatic cancer was evaluated.

Patients and methods: This single-center, retrospective study included consecutive patients with pancreatic cancer who underwent both surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced computed tomography (CE-CT) examinations between April 2015 and August 2017. CH-EUS evaluation was performed during the late phase. Portal vein invasion on EUS and CH-EUS was defined as no continuity in the line of the vessel wall. Definition of portal vein invasion on CE-CT was based on the Loyer's criteria. The accuracy of three modalities for diagnosis of invasion into the portal vein was compared using the McNemar's test.

Results: Eighty-eight patients (mean age: 71.0 years, ratio of male to female: 48:40) were eligible. Postoperative pathological results were as follows: seven cases of portal vein invasion; 81 cases without. Diagnostic accuracy of EUS, CH-EUS, and CE-CT for diagnosing invasion into the portal vein was 72.7%, 93.2%, and 81.8%, respectively. The differences between CH-EUS and CE-CT (P = 0.0094) and CH-EUS and EUS (P = 0.0022) were significant. EUS and CE-CT were comparable.

Conclusion: CH-EUS is useful for diagnosis of portal vein invasion by pancreatic cancer.

Keywords: Loyer's Criteria; contrast-enhanced computed tomography; contrast-enhanced harmonic EUS; pancreatic cancer; portal vein invasion.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
EUS image showing the contact between the tumor and the portal vein and that portal vein wall is unclear (arrowhead)
Figure 2
Figure 2
Contrast-enhanced harmonic EUS image using THE mode showing no portal vein invasion. The portal vein wall is depicted as a single-layer avascular line, with no interruption (arrowheads)
Figure 3
Figure 3
Contrast-enhanced computed tomography image showing portal vein invasion. The tumor is in contact with the portal vein (arrowhead)
Figure 4
Figure 4
Histopathological image of the tumor (hematoxylin and eosin stain) in a case with underdiagnosis of contrast-enhanced harmonic EUS (i.e., misdiagnosis of a positive case as negative). The tumor has invaded the tunica adventitia of the portal vein, but not the tunica intima (area surrounded by yellow line)
See this image and copyright information in PMC

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