Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Abstract Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting. Methods Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection. Results 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of lesions were stiffer than the surrounding pancreatic parenchyma (stiff lesions) and 50 % were less stiff or of similar stiffness (soft lesions). High stiffness of the lesion had a sensitivity of 84 % (95 % confidence interval 73 % – 91 %), specificity of 67 % (58 % – 74 %), positive predictive value (PPV) of 56 % (50 % – 62 %), and negative predictive value (NPV) of 89 % (83 % – 93 %) for the diagnosis of malignancy. For the diagnosis of pancreatic ductal adenocarcinoma, the sensitivity, specificity, PPV, and NPV were 96 % (87 % – 100 %), 64 % (56 % – 71 %), 45 % (40 % – 50 %), and 98 % (93 % – 100 %), respectively. Conclusions In patients with small solid pancreatic lesions, EUS elastography can rule out malignancy with a high level of certainty if the lesion appears soft. A stiff lesion can be either benign or malignant.

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Diagnosis of vascular invasion in pancreatic ductal adenocarcinoma using endoscopic ultrasound elastography

10.21203/rs.2.21495/v2 ◽

2020 ◽

Author(s):

Kenta Yamada ◽

Hiroki Kawashima ◽

Eizaburo Ohno ◽

Takuya Ishikawa ◽

Hiroyuki Tanaka ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Endoscopic Ultrasound ◽

Vascular Invasion ◽

Ultrasound Elastography ◽

Ductal Adenocarcinoma ◽

Histopathological Diagnosis ◽

Dynamic Ct ◽

Pathological Evaluation ◽

Eus Elastography ◽

Sensitivity Specificity

Abstract Background: Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC.Methods: The subjects were 44 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. Results: In 44 subjects (48 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.697 and 0.708 on dynamic CT (48 sites); 0.733, 0.606 and 0.646 in EUS B-mode (48 sites); and 0.917, 0.900 and 0.906 in EUS-EG (32 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG.Conclusions: These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.Trial registration: UMIN 000016497

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Accuracy and other quality indicators of solid pancreatic mass endoscopic ultrasound-guided fine needle aspiration and biopsy in two academic endoscopy centers

Acta Gastro Enterologica Belgica ◽

10.51821/84.3.010 ◽

2021 ◽

Vol 84 (3) ◽

Author(s):

M Figueiredo ◽

M Arvanitakis ◽

A Zaarour ◽

E Toussaint ◽

J Devière ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Predictive Value ◽

High Specificity ◽

Final Diagnosis ◽

Needle Aspiration ◽

Tissue Acquisition ◽

Final Interpretation ◽

Solid Lesions ◽

Acquisition Method

Background and aims : Endoscopic ultrasound fine-needleaspiration/biopsy (EUS-FNA/FNB) is highly accurate, but dis-crepancies between cytological and surgical diagnoses are stillobserved. We aimed to determine its accuracy and monitor qualityindicators in our facilities. Patients and methods : We performed a retrospective review ofall cases of pancreatic solid lesions evaluated by EUS-FNA/FNB,between July 2015 and June 2018, in two centers. Cytologicaland surgical findings were categorized into five groups: benign,malignant, suspect of malignancy, undetermined and insufficientfor diagnosis. Final diagnosis was based on surgical diagnosis and,in patients who did not undergo surgery, on clinical outcome after6 months follow-up. Results : Altogether, 142 patients were included. FNA was thepreferred tissue acquisition method (88%), with a predilection forthe FNA 22G needle (57%). Cytology was insufficient for diagnosisin 2 cases, therefore a full diagnostic sample was available in 98.6%of the patients (>90%, ESGE target). Fifty-five (38.7%) patientsunderwent surgery. In term of cancer diagnosis, comparison withfinal surgical pathology (n=55) revealed 89% true positives, 5.5%true negatives, 3.6% false positives and 1.8% false negatives. Whencombining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was92.3% (74.9-99.1), positive predictive value was 98.2% (93.6-99.5),negative predictive value was 88.9% (72.3-96.1) and accuracy was96.4% (91.9-98.8). Post-procedural acute pancreatitis was reportedin 2 patients (1.4%). Conclusions : These results reveal a performance for diagnostictissue sampling well above the ESGE proposed target standard.Also, the uncommon high specificity illustrates the determiningrole of the pathologist’s final interpretation and diagnosis.

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Diagnosis of vascular invasion in pancreatic ductal adenocarcinoma using endoscopic ultrasound elastography

10.21203/rs.2.21495/v1 ◽

2020 ◽

Author(s):

Kenta Yamada ◽

Hiroki Kawashima ◽

Eizaburo Ohno ◽

Takuya Ishikawa ◽

Hiroyuki Tanaka ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Endoscopic Ultrasound ◽

Vascular Invasion ◽

Ultrasound Elastography ◽

Ductal Adenocarcinoma ◽

Histopathological Diagnosis ◽

Dynamic Ct ◽

Pathological Evaluation ◽

Eus Elastography ◽

Sensitivity Specificity

Abstract Background Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC. Methods The subjects were 58 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. Results In 58 subjects (62 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.787 and 0.774 on dynamic CT (62 sites); 0.733, 0.787 and 0.774 in EUS B-mode (62 sites); and 0.917, 0.889 and 0.897 in EUS-EG (39 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG. Conclusions These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.

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Analysis of circulating cell-free DNA after endoscopic ultrasound-guided fine needle aspiration in pancreatic ductal adenocarcinoma

Pancreatology ◽

10.1016/j.pan.2021.04.001 ◽

2021 ◽

Author(s):

Kosho Asano ◽

Rintaro Mikata ◽

Tetsuhiro Chiba ◽

Motoyasu Kan ◽

Shikiko Maruta ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Ductal Adenocarcinoma ◽

Ultrasound Guided ◽

Cell Free Dna ◽

Fine Needle ◽

Free Dna ◽

Circulating Cell Free Dna

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Cystic pancreatic lesions: MR imaging findings and management

Insights into Imaging ◽

10.1186/s13244-021-01060-z ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Giovanni Morana ◽

Pierluigi Ciet ◽

Silvia Venturini

Keyword(s):

Differential Diagnosis ◽

Endoscopic Ultrasound ◽

Needle Biopsy ◽

Main Pancreatic Duct ◽

Final Diagnosis ◽

Needle Aspiration ◽

Morphological Findings ◽

History Of ◽

Cystic Pancreatic Lesions ◽

Radiological Examinations

AbstractCystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

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Insulin-like growth factor 2 binding protein 3 expression on endoscopic ultrasound guided fine needle aspiration specimens in pancreatic ductal adenocarcinoma

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001696 ◽

2020 ◽

Vol 32 (4) ◽

pp. 496-500

Author(s):

Mario Tadic ◽

Tajana Stoos-Veic ◽

Milan Kujundzic ◽

Petra Turcic ◽

Gorana Aralica ◽

...

Keyword(s):

Growth Factor ◽

Pancreatic Ductal Adenocarcinoma ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Binding Protein ◽

Needle Aspiration ◽

Ductal Adenocarcinoma ◽

Insulin Like Growth Factor ◽

Ultrasound Guided ◽

Fine Needle

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Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound-guided fine needle aspiration samples

Pancreatology ◽

10.1016/j.pan.2011.12.003 ◽

2012 ◽

Vol 12 (1) ◽

pp. 27-34 ◽

Cited By ~ 36

Author(s):

B. Bournet ◽

A. Pointreau ◽

A. Souque ◽

N. Oumouhou ◽

F. Muscari ◽

...

Keyword(s):

Gene Expression ◽

Pancreatic Ductal Adenocarcinoma ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Gene Expression Signature ◽

Needle Aspiration ◽

Ductal Adenocarcinoma ◽

Low Density ◽

Ultrasound Guided ◽

Fine Needle

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Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

Journal of Telemedicine and Telecare ◽

10.1258/jtt.2011.110706 ◽

2012 ◽

Vol 18 (5) ◽

pp. 253-259 ◽

Cited By ~ 21

Author(s):

Kamal K Khurana ◽

Rong Rong ◽

Dongliang Wang ◽

Ajoy Roy

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Final Diagnosis ◽

Needle Aspiration ◽

Neuroendocrine Neoplasms ◽

Ultrasound Guided ◽

Fine Needle ◽

Preliminary Diagnosis ◽

Site Evaluation ◽

Conventional Microscopy

We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.

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Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses – a prospective validation study

Endoscopy International Open ◽

10.1055/s-0043-121987 ◽

2018 ◽

Vol 06 (01) ◽

pp. E78-E85 ◽

Cited By ~ 10

Author(s):

John Karstensen ◽

Tatiana Cârţână ◽

Codruţa Constantinescu ◽

Silviu Dumitrașcu ◽

Bojan Kovacevic ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Final Diagnosis ◽

Diagnostic Value ◽

Needle Aspiration ◽

Observer Agreement ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Dark Cell ◽

Pancreatic Masses ◽

Pass Through

Abstract Background and study aims Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a keystone in diagnosing and staging of pancreatic masses. Recently, a microfiber that can pass through a 19-gauge needle has been introduced for confocal laser endomicroscopy (nCLE). The aims of this study were to evaluate the diagnostic value and the reproducibility of nCLE criteria for solid malignant lesions. Patients and methods This prospective dual-center study included patients with pancreatic masses suspicious of malignancy referred for EUS-FNA. Endomicroscopic imaging was performed under EUS-guidance until organ-specific structures were obtained. Afterwards, standard cytology was obtained and patients were followed for up to 12 months. All nCLE parameters included in former studies were correlated with the final diagnosis (dark lobular structures/normal acinar cells, dark cell aggregates > 40 µm, dilated irregular vessels with fluorescein leakage, fine white fibrous bands, small black cell movements, pseudoglandular structures). Finally, three CLE novices and three CLE experts assessed the unedited movies from all patients. Results Twenty-eight patients were enrolled in the study. A final diagnosis was obtained in 24 patients (86 %). One patient (3 %) died before a diagnosis was obtained, while 3 were lost to follow-up (11 %). In 18/24 patients (74 %) the diagnosis was malignant. The mean sensitivity, specificity, and accuracy for the nCLE parameters ranged from 19 – 93 %, 0 – 56 %, 26 – 69 %, respectively. The inter-observer values ranged from κ = 0.20 – 0.41 for novices and κ = –0.02 – 0.38 for experts. Conclusions The diagnostic value of nCLE in solid pancreatic masses is questionable and the inter-observer agreement for both novices and CLE experts appears limited.

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