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Evaluation of the diagnostic performance of the EFSUMB CEUS Pancreatic Applications guidelines (2017 version): a retrospective single-center analysis of 455 solid pancreatic masses

  • Ultrasound
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Abstract

Objectives

To explore the diagnostic performance of EFSUMB CEUS Pancreatic Applications guidelines (version 2017) before and after the addition of iso-enhancement and very fast/fast washout as supplementary diagnostic criteria for PDAC.

Methods

In this retrospective study, patients diagnosed with solid pancreatic lesions from January 2017 to December 2020 were evaluated. Pancreatic ductal adenocarcinoma (PDAC) is reported to show hypo-enhancement in all phases according to the EFSUMB guidelines. First, based on this definition, all lesions were categorized as PDAC and non-PDAC. Then, iso-enhancement and very fast/fast washout were added as supplementary diagnostic criteria, and all lesions were recategorized. The diagnostic performance was assessed in terms of the accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV). The reference standard consisted of histologic evaluation or composite imaging and clinical follow-up findings.

Results

A total of 455 nodules in 450 patients (median age, 58.37 years; 250 men) were included. The diagnostic performance using the EFSUMB CEUS guidelines for PDAC had an ACC of 69.5%, SEN of 65.4%, SPE of 84%, PPV of 93.5%, NPV of 40.6%, and ROC of 0.747. After recategorization according to the supplementary diagnostic criteria, the diagnostic performance for PDAC had an ACC of 95.8%, SEN of 99.2%, SPE of 84%, PPV of 95.7%, NPV of 96.6%, and ROC of 0.916.

Conclusion

The EFSUMB guidelines and recommendations for pancreatic lesions can effectively identify PDAC via hypo-enhancement on CEUS. However, the diagnostic performance may be further improved by the reclassification of PDAC lesions after adding iso-enhancement and very fast/fast washout mode.

Key Points

• In the EFSUMB guidelines, the only diagnostic criterion for PDAC is hypo-enhancement, to which iso-enhancement and very fast/fast washout mode were added in our research.

• Using hypo-enhancement/iso-enhancement with very fast/fast washout patterns as the diagnostic criteria for PDAC for solid pancreatic masses on CEUS has high diagnostic accuracy.

• The blood supply pattern of PDAC can provide important information, and CEUS has unique advantages in this respect due to its real-time dynamic attenuation ability.

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Abbreviations

CECT:

Contrast-enhanced computed tomography

CEUS:

Contrast-enhanced ultrasound

Hyper-E:

Hyper-enhancement

Hypo-E:

Hypo-enhancement

Iso-E:

Iso-enhancement

PDAC:

Pancreatic ductal adenocarcinoma

ROC:

Receiver operating characteristic

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Funding

The work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2020-I2M-C and T-B-039) and the National Natural Science Foundation of China (Grant No. 81873902 and No. 82171968).

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Author notes

  1. Wan-ying Jia and Yang Gui are contributed equally in this work.

Authors and Affiliations

  1. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Wan-ying Jia, Yang Gui, Xue-qi Chen, Li Tan, Jian-chu Li, Ke Lv & Yu-xin Jiang

  2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Xiao-qian Zhang & Jia-hui Zhang

  3. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Meng-hua Dai & Jun-chao Guo

  4. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Xiao-yan Chang

  5. Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Chun-mei Bai & Yue-juan Cheng

Authors
  1. Wan-ying Jia
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Corresponding author

Correspondence to Ke Lv.

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The scientific guarantor of this publication is Ke Lv.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Jia, Wy., Gui, Y., Chen, Xq. et al. Evaluation of the diagnostic performance of the EFSUMB CEUS Pancreatic Applications guidelines (2017 version): a retrospective single-center analysis of 455 solid pancreatic masses. Eur Radiol 32, 8485–8496 (2022). https://doi.org/10.1007/s00330-022-08879-0

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