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Efficacy of Contrast-Enhanced Harmonic Endoscopic Ultrasound for Pancreatic Solid Tumors with a Combination of Qualitative and Quantitative Analyses: A Prospective Pilot Study

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Abstract

Introduction

Image evaluation of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and additional time-intensity curve (TIC) analysis enable qualitative and quantitative analyses of pancreatic tumor based on real-time perfusion imaging.

Aims

To evaluate the efficacy of CEH-EUS with a combination of qualitative and quantitative analyses of pancreatic solid tumors.

Methods

Patients were scheduled to undergo EUS-guided fine needle aspiration (FNA) for pancreatic solid tumors were prospectively enrolled between 11/2016 and 12/2018 and underwent CEH-EUS. The vascular and enhancement patterns were qualitatively evaluated and heterogeneous enhancement was defined to be indicative of malignancy. The echo intensity change during 60 s in the tumor was quantitatively evaluated by time intensity curve analysis.

Results

In total, 100 patients were enrolled in this study. The final diagnoses were malignant lesions in 87 patients and benign legions in 13 patients. There were four categories of enhancement and patterns: hypovascular with heterogeneous, hypovascular with homogeneous, hypervascular heterogeneous, and hypervascular homogeneous enhancement. The diagnostic capability of qualitative analysis was the sensitivity, specificity, and accuracy of 89%, 62%, and 85%, respectively. With respect to time intensity curve analysis, the time to peak of malignant lesions was significantly shorter than those of benign lesions (P = 0.0009) with an optimal cutoff value of 12.81 s on the receiver operating characteristic curve analysis. With the combination of qualitative and quantitative analyses, the sensitivity, specificity, and accuracy were improved to 100%, 54%, and 94%, respectively.

Conclusions

CEH-EUS with combined qualitative and quantitative analyses for pancreatic tumors might be useful as a complement for EUS-FNA.

The UMIN Clinical Trials Registry (UMIN000025192)

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

EUS:

Endoscopic ultrasound

CEH-EUS:

Contrast-enhanced harmonic EUS

TIC:

Time intensity curve

ROI:

Region of interest

FNA:

Fine needle aspiration

PPV:

Positive predictive value

NPV:

Negative predictive value

ROC:

Receiver operating characteristic

NEN:

Neuroendocrine neoplasm

AUC:

Area under the curve

AIP:

Autoimmune pancreatitis

TFP:

Tumor-forming pancreatitis

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Authors and Affiliations

  1. First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

    Yuhei Iwasa, Takuji Iwashita, Hironao Ichikawa, Naoki Mita, Shinya Uemura & Masahito Shimizu

  2. Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan

    Kensaku Yoshida & Keisuke Iwata

  3. Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan

    Tsuyoshi Mukai

  4. Third Department of Internal Medicine, University of Toyama Hospital, Toyama, Japan

    Ichiro Yasuda

Authors
  1. Yuhei Iwasa
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Contributions

YI and TI wrote the manuscript. YI, TI, HI, NM, SU, KI, TM, and MS managed the patients. TI and IY supervised the study.

Corresponding author

Correspondence to Takuji Iwashita.

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Conflict of interest

Yuhei Iwasa, Takuji Iwashita, Shinya Uemura, Naoki Mita, Hironao Ichikawa, Keisuke Iwata, Tsuyoshi Mukai, Ichiro Yasuda, and Masahito Shimizu do not have any Conflict of Interest needed to be declared.

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Iwasa, Y., Iwashita, T., Ichikawa, H. et al. Efficacy of Contrast-Enhanced Harmonic Endoscopic Ultrasound for Pancreatic Solid Tumors with a Combination of Qualitative and Quantitative Analyses: A Prospective Pilot Study. Dig Dis Sci 67, 1054–1064 (2022). https://doi.org/10.1007/s10620-021-06931-5

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  • DOI: https://doi.org/10.1007/s10620-021-06931-5

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