Skip to main content
SpringerLink
Log in

A Prospective Study on Contrast-Enhanced Endoscopic Ultrasound for Differential Diagnosis of Pancreatic Cystic Neoplasms

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

To determine the value of contrast-enhanced endoscopic ultrasound (CE-EUS) for differentiation of pancreatic cystic neoplasms (PCNs).

Methods

From April 2015 to December 2017, 82 patients were enrolled in this study. All patients were confirmed to have PCNs by surgical pathology. Prior to surgery, all patients underwent fundamental B-mode EUS (FB-EUS) and CE-EUS, 65 of whom underwent computed tomography (CT) and 71 of whom underwent magnetic resonance imaging (MRI). The enhanced mode data of PCNs were recorded. The diagnostic accuracy of CE-EUS in classifying PCNs was compared with that of CT, MRI and FB-EUS. The ability of CE-EUS to identify PCNs was evaluated by comparing the enhanced mode of PCNs.

Results

There was a significant difference between benign and malignant lesions in enhanced mode (P = 0.017). The enhanced modes of benign lesions were mostly type II and type III, while those of malignant lesions were type 0, type I, and type IV. The sensitivity, specificity, and accuracy of type 0, type I, and type IV enhanced mode as the diagnostic criterion for malignant lesions were 80%, 65.3%, and 67.1%, respectively. CE-EUS demonstrated greater accuracy in identifying PCNs than did CT, MRI, and FB-EUS (CE-EUS vs. CT: 92.3% vs. 76.9%; CE-EUS vs. MRI: 93.0% vs. 78.9%; CE-EUS vs. FB-EUS: 92.7% vs. 84.2%).

Conclusion

Compared with CT, MRI, and FB-EUS, CE-EUS is better at differentiating PCNs. CE-EUS is expected to be another important imaging technique for the diagnosis of PCNs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fernandez-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin N Am. 1995;75:1001–1016.

    Article  CAS  Google Scholar 

  2. Xu M, Xie XY, Liu GJ, et al. The application value of contrast-enhanced ultrasound in the differential diagnosis of pancreatic solid-cystic lesions. Eur J Radiol. 2012;81:1432–1437.

    Article  Google Scholar 

  3. Cohen-Scali F, Vilgrain V, Brancatelli G, et al. Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations. Radiology. 2003;228:727–733.

    Article  Google Scholar 

  4. Tsujino T, Yan-Lin Huang J, Nakai Y, Samarasena JB, Lee JG, Chang KJ. In vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy. Best Pract Res Clin Gastroenterol. 2015;29:601–610.

    Article  Google Scholar 

  5. Bhutani MS. Role of endoscopic ultrasound for pancreatic cystic lesions: past, present, and future! Endosc Ultrasound. 2015;4:273–275.

    Article  Google Scholar 

  6. Fusaroli P, Serrani M, De Giorgio R, et al. Contrast harmonic-endoscopic ultrasound is useful to identify neoplastic features of pancreatic cysts (with videos). Pancreas. 2016;45:265–268.

    Article  Google Scholar 

  7. Fusaroli P, Spada A, Mancino MG, Caletti G. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol. 2010;8:629–634.

    Article  Google Scholar 

  8. Kitano M, Kudo M, Yamao K, et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol. 2012;107:303–310.

    Article  Google Scholar 

  9. Gincul R, Palazzo M, Pujol B, et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy. 2014;46:373–379.

    Article  Google Scholar 

  10. Fusaroli P, D’Ercole MC, De Giorgio R, Serrani M, Caletti G. Contrast harmonic endoscopic ultrasonography in the characterization of pancreatic metastases (with video). Pancreas. 2014;43:584–587.

    Article  Google Scholar 

  11. Yamashita Y, Ueda K, Itonaga M, et al. Usefulness of contrast-enhanced endoscopic sonography for discriminating mural nodules from mucous clots in intraductal papillary mucinous neoplasms: a single-center prospective study. J Ultrasound Med. 2013;32:61–68.

    Article  Google Scholar 

  12. Hocke M, Cui XW, Domagk D, Ignee A, Dietrich CF. Pancreatic cystic lesions: the value of contrast-enhanced endoscopic ultrasound to influence the clinical pathway. Endosc Ultrasound. 2014;3:123–130.

    Article  Google Scholar 

  13. Basturk O, Hong SM, Wood LD, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39:1730–1741.

    Article  Google Scholar 

  14. Kamata K, Kitano M, Omoto S, et al. Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy. 2016;48:35–41.

    Article  Google Scholar 

  15. Jani N, Bani Hani M, Schulick RD, Hruban RH, Cunningham SC. Diagnosis and management of cystic lesions of the pancreas. Diagn Ther Endosc. 2011;2011:478913.

    Article  Google Scholar 

  16. D’Onofrio M, Malago R, Zamboni G, et al. Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology. 2005;5:398–402.

    Article  Google Scholar 

  17. Degen L, Wiesner W, Beglinger C. Cystic and solid lesions of the pancreas. Best Pract Res Clin Gastroenterol. 2008;22:91–103.

    Article  Google Scholar 

  18. Reid MD, Choi HJ, Memis B, et al. Serous neoplasms of the pancreas: a clinicopathologic analysis of 193 cases and literature review with new insights on macrocystic and solid variants and critical reappraisal of so-called “serous cystadenocarcinoma”. Am J Surg Pathol. 2015;39:1597–1610.

    Article  Google Scholar 

  19. D’Onofrio M, Gallotti A, Pozzi MR. Imaging techniques in pancreatic tumors. Expert Rev Med Devices. 2010;7:257–273.

    Article  Google Scholar 

  20. Napoleon B, Lemaistre AI, Pujol B, et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy. 2015;47:26–32.

    Article  Google Scholar 

  21. Yamamoto N, Kato H, Tomoda T, et al. Contrast-enhanced harmonic endoscopic ultrasonography with time-intensity curve analysis for intraductal papillary mucinous neoplasms of the pancreas. Endoscopy. 2016;48:26–34.

    PubMed  Google Scholar 

  22. Cho HW, Choi JY, Kim MJ, et al. Pancreatic tumors: emphasis on CT findings and pathologic classification. Korean J Radiol. 2011;12:731–739.

    Article  Google Scholar 

  23. Matos JM, Grutzmann R, Agaram NP, et al. Solid pseudopapillary neoplasms of the pancreas: a multi-institutional study of 21 patients. J Surg Res. 2009;157:e137–e142.

    Article  Google Scholar 

  24. Martin RC, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg Oncol. 2002;9:35–40.

    Article  Google Scholar 

  25. Lieber MR, Lack EE, Roberts JR Jr, et al. Solid and papillary epithelial neoplasm of the pancreas. An ultrastructural and immunocytochemical study of six cases. Am J Surg Pathol. 1987;11:85–93.

    Article  CAS  Google Scholar 

  26. Farrell JJ, Fernandez-del CC. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology. 2013;144:1303–1315.

    Article  Google Scholar 

  27. Bordeianou L, Vagefi PA, Sahani D, et al. Cystic pancreatic endocrine neoplasms: a distinct tumor type? J Am Coll Surg. 2008;206:1154–1158.

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by the Scientific Research Fund of Army of China (No. 14BJZ01).

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China

    Lisen Zhong, Ningli Chai, Enqiang Linghu, Huikai Li, Jing Yang & Ping Tang

Authors
  1. Lisen Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ningli Chai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enqiang Linghu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huikai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ping Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enqiang Linghu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhong, L., Chai, N., Linghu, E. et al. A Prospective Study on Contrast-Enhanced Endoscopic Ultrasound for Differential Diagnosis of Pancreatic Cystic Neoplasms. Dig Dis Sci 64, 3616–3622 (2019). https://doi.org/10.1007/s10620-019-05718-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05718-z

Keywords

Search

Navigation