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Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens)

  • Original Article—LIVER, PANCREAS, AND BILIARY TRACT
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

An accurate diagnosis of pancreatic fibrosis is clinically important and may have potential for staging chronic pancreatitis. The aim of this study was to diagnose the grade of pancreatic fibrosis through a quantitative analysis of endoscopic ultrasound elastography (EUS-EG).

Methods

From September 2004 to October 2010, 58 consecutive patients examined by EUS-EG for both pancreatic tumors and their upstream pancreas before pancreatectomy were enrolled. Preoperative EUS-EG images in the upstream pancreas were statistically quantified, and the results were retrospectively compared with postoperative histological fibrosis in the same area. For the quantification of EUS-EG images, 4 parameters (mean, standard deviation, skewness, and kurtosis) were calculated using novel software. Histological fibrosis was graded into 4 categories (normal, mild fibrosis, marked fibrosis, and severe fibrosis) according to a previously reported scoring system.

Results

The fibrosis grade in the upstream pancreas was normal in 24 patients, mild fibrosis in 19, marked fibrosis in 6, and severe fibrosis in 9. Fibrosis grade was significantly correlated with all 4 quantification parameters (mean r = −0.75, standard deviation r = −0.54, skewness r = 0.69, kurtosis r = 0.67). According to the receiver operating characteristic analysis, the mean was the most useful parameter for diagnosing pancreatic fibrosis. Using the mean, the area under the ROC curves for the diagnosis of mild or higher-grade fibrosis, marked or higher-grade fibrosis and severe fibrosis were 0.90, 0.90, and 0.90, respectively.

Conclusions

An accurate diagnosis of pancreatic fibrosis may be possible by analyzing EUS-EG images.

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Abbreviations

EUS:

Endoscopic ultrasonography

EG:

Elastography

EUS-EG:

Endoscopic ultrasound elastography

CP:

Chronic pancreatitis

EI:

Elasticity imaging

IPMN:

Intraductal papillary mucinous neoplasm

ROI:

Region of interest

ROC:

Receiver operating characteristic

AUC:

Area under the ROC curve

References

  1. Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet. 2011;377:1184–97.

    Article  CAS  PubMed  Google Scholar 

  2. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120:682–707.

    Article  CAS  PubMed  Google Scholar 

  3. Ammann RW, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology. 1999;116:1132–40.

    Article  CAS  PubMed  Google Scholar 

  4. Ammann RW, Heitz PU, Kloppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology. 1996;111:224–31.

    Article  CAS  PubMed  Google Scholar 

  5. Lohr JM. What are the useful biological and functional markers of early-stage chronic pancreatitis? J Gastroenterol. 2007;42(Suppl 17):66–71.

    Article  PubMed  Google Scholar 

  6. Catalano MF, Lahoti S, Geenen JE, Hogan WJ. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc. 1998;48:11–7.

    Article  CAS  PubMed  Google Scholar 

  7. Sahai AV, Zimmerman M, Aabakken L, Tarnasky PR, Cunningham JT, van Velse A, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc. 1998;48:18–25.

    Article  CAS  PubMed  Google Scholar 

  8. Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P, et al. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55:507–11.

    Article  PubMed  Google Scholar 

  9. Wallace MB, Durkalski VL, Vaughan J, Palesch YY, Libby ED, Jowell PS, et al. Age and alarm symptoms do not predict endoscopic findings among patients with dyspepsia: a multicentre database study. Gut. 2001;49:29–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Stevens T, Lopez R, Adler DG, Al-Haddad MA, Conway J, Dewitt JM, et al. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71:519–26.

    Article  PubMed  Google Scholar 

  11. Kalmin B, Hoffman B, Hawes R, Romagnuolo J, et al. Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: comparing interobserver reliability and intertest agreement. Can J Gastroenterol. 2011;25:261–4.

    PubMed Central  PubMed  Google Scholar 

  12. Lieb JG 2nd, Palma DT, Garvan CW, Leblanc JK, Romagnuolo J, Farrell JJ, et al. Intraobserver agreement among endosonographers for endoscopic ultrasound features of chronic pancreatitis: a blinded multicenter study. Pancreas. 2011;40:177–80.

    Article  PubMed  Google Scholar 

  13. Hirooka Y, Itoh A, Kawashima H, Ohno E, Itoh Y, Nakamura Y, et al. Contrast-enhanced endoscopic ultrasonography in digestive diseases. J Gastroenterol. 2012;47(10):1063–72.

    Article  PubMed  Google Scholar 

  14. Shiina T, Yamakawa M. Fast reconstruction of tissue elastic modulus image by ultrasound. Conf Proc IEEE Eng Med Biol Soc. 2005;1:976–80.

    PubMed  Google Scholar 

  15. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.

    Article  PubMed  Google Scholar 

  16. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.

    Article  PubMed  Google Scholar 

  17. Hirooka Y, Itoh A, Kawashima H, Ohno E, Ishikawa T, Matsubara H, et al. Diagnosis of pancreatic disorders using contrast-enhanced endoscopic ultrasonography and endoscopic elastography. Clin Gastroenterol Hepatol. 2009;7:S63–7.

    Article  PubMed  Google Scholar 

  18. Hirooka Y, Itoh A, Kawashima H, Ohno E, Ishikawa T, Itoh Y, et al. Clinical oncology for pancreatic and biliary cancers: advances and current limitations. World J Clin Oncol. 2011;2:217–24.

    PubMed Central  PubMed  Google Scholar 

  19. Uchida H, Hirooka Y, Itoh A, Kawashima H, Hara K, Nonogaki K, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas. 2009;38:17–22.

    Article  PubMed  Google Scholar 

  20. Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc. 2007;65:971–8.

    Article  PubMed  Google Scholar 

  21. Giovannini M, Thomas B, Erwan B, Christian P, Fabrice C, Benjamin E, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol. 2009;15:1587–93.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139:1172–80.

    Article  PubMed  Google Scholar 

  23. Itokawa F, Itoi T, Sofuni A, Kurihara T, Tsuchiya T, Ishii K, et al. EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. J Gastroenterol. 2011;46:843–53.

    Article  PubMed  Google Scholar 

  24. Saftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011;43:596–603.

    Article  CAS  PubMed  Google Scholar 

  25. Saftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, et al. Efficacy of an artificial neural network-based approach to endoscopic ultrasound elastography in diagnosis of focal pancreatic masses. Clin Gastroenterol Hepatol. 2012;10(1):84–90.e1.

    Article  Google Scholar 

  26. Wellner UF, Kayser G, Lapshyn H, Sick O, Makowiec F, Höppner J, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB (Oxford). 2010;12:696–702.

    Article  Google Scholar 

  27. Kloppel G, Detlefsen S, Feyerabend B. Fibrosis of the pancreas: the initial tissue damage and the resulting pattern. Virchows Arch. 2004;445:1–8.

    Article  PubMed  Google Scholar 

  28. World Medical Association Inc. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc. 2009;107:403-5.

    Google Scholar 

  29. Haralick RM, Shanmuga K, Dinstein I. Textural Features for Image Classification. IEEE T Syst Man Cyb. 1973;Smc3:610–21.

    Article  Google Scholar 

  30. Kloppel G, Maillet B. Pseudocysts in chronic pancreatitis: a morphological analysis of 57 resection specimens and 9 autopsy pancreata. Pancreas. 1991;6:266–74.

    Article  CAS  PubMed  Google Scholar 

  31. Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas. 1997;14:215–21.

    Article  CAS  PubMed  Google Scholar 

  32. Olsen TS. Lipomatosis of the pancreas in autopsy material and its relation to age and overweight. Acta Pathol Microbiol Scand A. 1978;86A:367–73.

    CAS  PubMed  Google Scholar 

  33. Schmitz-Moormann P, Pittner PM, Heinze W. Lipomatosis of the pancreas. Pathol Res Pract. 1981;173:45–53.

    Article  CAS  PubMed  Google Scholar 

  34. Morikawa H, Fukuda K, Kobayashi S, Fujii H, Iwai S, Enomoto M, et al. Real-time tissue elastography as a tool for the noninvasive assessment of liver stiffness in patients with chronic hepatitis C. J Gastroenterol. 2011;46:350–8.

    Article  PubMed  Google Scholar 

  35. Havre RF, Elde E, Gilja OH, Odegaard S, Eide GE, Matre K, et al. Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations. Ultrasound Med Biol. 2008;34:1638–50.

    Article  PubMed  Google Scholar 

  36. Albashir S, Bronner MP, Parsi MA, Walsh RM, Stevens T. Endoscopic ultrasound, secretin endoscopic pancreatic function test, and histology: correlation in chronic pancreatitis. Am J Gastroenterol. 2010;105:2498–503.

    Article  PubMed  Google Scholar 

  37. Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25:756–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Chong AK, Hawes RH, Hoffman BJ, Adams DB, Lewin DN, Romagnuolo J. Diagnostic performance of EUS for chronic pancreatitis: a comparison with histopathology. Gastrointest Endosc. 2007;65:808–14.

    Article  PubMed  Google Scholar 

  39. Hollerbach S, Klamann A, Topalidis T, Schmiegel WH. Endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) cytology for diagnosis of chronic pancreatitis. Endoscopy. 2001;33:824–31.

    Article  CAS  PubMed  Google Scholar 

  40. DeWitt J, McGreevy K, LeBlanc J, McHenry L, Cummings O, Sherman S. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc. 2005;62:76–84.

    Article  PubMed  Google Scholar 

  41. Suda K, Mogaki M, Oyama T, Matsumoto Y. Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: special emphasis on ductal obstruction and genesis of pancreatitis. Am J Gastroenterol. 1990;85:271–6.

    CAS  PubMed  Google Scholar 

  42. Koizumi Y, Hirooka M, Kisaka Y, Konishi I, Abe M, Murakami H, et al. Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography—establishment of the method for measurement. Radiology. 2011;258:610–7.

    Article  PubMed  Google Scholar 

  43. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc. 2009;70:1101–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the Research Committee of Intractable Pancreatic Diseases provided by the Ministry of Health, Labour and Welfare of Japan.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-Ku, Nagoya, 466-8550, Japan

    Yuya Itoh, Akihiro Itoh, Hiroki Kawashima, Takeshi Hiramatsu, Hiroyuki Sugimoto, Hajime Sumi, Daijuro Hayashi, Takamichi Kuwahara, Tomomasa Morishima, Masanao Nakamura, Ryoji Miyahara, Naoki Ohmiya, Yoshiaki Katano, Masatoshi Ishigami & Hidemi Goto

  2. Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-Cho, Showa-Ku, Nagoya, 466-8550, Japan

    Eizaburo Ohno, Yosuke Nakamura, Kohei Funasaka, Hidemi Goto & Yoshiki Hirooka

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Correspondence to Yoshiki Hirooka.

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Itoh, Y., Itoh, A., Kawashima, H. et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol 49, 1183–1192 (2014). https://doi.org/10.1007/s00535-013-0880-4

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  • DOI: https://doi.org/10.1007/s00535-013-0880-4

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