Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA.

Autor: Iordache S; Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania., Costache MI; Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania., Popescu CF; Cytology Laboratory, Pathology Department, Clinical Emergency County Hospital Craiova, Romania., Streba CT; Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania., Cazacu S; Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania., Săftoiu A; Gastroenterology Department, Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark. adrian.saftoiu@umfcv.ro.
Jazyk: angličtina
Zdroj: Medical ultrasonography [Med Ultrason] 2016 Mar; Vol. 18 (1), pp. 18-24.
DOI: 10.11152/mu.2013.2066.181.ich
Abstrakt: Aims: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS.
Material and Methods: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established.
Results: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer.
Conclusions: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.
Databáze: MEDLINE
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