Clin Endosc.  2019 Jul;52(4):360-364. 10.5946/ce.2018.160.

Diagnostic Efficacy of Endoscopic Ultrasound Elastography in Differentiating Solid Pancreatic Lesions: A Single-Center Experience

• Altonbary
• Hakim H
• El-Shamy A

• KMID: 2455633
• DOI: http://doi.org/10.5946/ce.2018.160

Abstract

BACKGROUND/AIMS
Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions.
METHODS
The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed.
RESULTS
In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%.
CONCLUSIONS
The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.

Keyword

Endoscopic ultrasound; Elasticity imaging techniques; Strain ratio; Pancreas

MeSH Terms

Biopsy, Fine-Needle
Elasticity
Elasticity Imaging Techniques*
Female
Hardness
Humans
Male
Methods
Pancreas
Retrospective Studies
Sensitivity and Specificity
Ultrasonography*

Figure

• 

  Fig. 1. Elasticity score (ES) 1 was given to homogeneous green area and indicated normal tissue (arrow). ES 2 was given to heterogeneous green area predominant and indicated fibrosis or inflammation. ES 3 was given to heterogeneous blue predominant and indicated indeterminate for malignancy. ES 4 was given to homogeneous blue and indicated malignant lesions. The strain ratio was calculated in ES 3 and 4.

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