Endoscopy 2018; 50(11): 1071-1079
DOI: 10.1055/a-0588-4941
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Andre Ignee
 1   Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
Christian Jenssen
 2   Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
Paolo G. Arcidiacono
 3   Pancreato-Biliary Endoscopy and Endosonography Division, Vita Salute San Raffaele University, Milan, Italy
Michael Hocke
 4   Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany
Kathleen Möller
 5   Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
Adrian Saftoiu
 6   Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
Uwe Will
 7   SRH Wald Klinikum Gera, Germany
Pietro Fusaroli
 8   Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna, Hospital of Imola, Italy
Julio Iglesias-Garcia
 9   Gastroenterology and Hepatology Department, University Hospital, Santiago de Compostela, Spain
Ryan Ponnudurai
10   Division of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
Maria C. Petrone
 3   Pancreato-Biliary Endoscopy and Endosonography Division, Vita Salute San Raffaele University, Milan, Italy
Barbara Braden
11   Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Eike Burmester
12   Medical Department I, Sana Hospital Lübeck, Germany
Yi Dong
13   Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
Nathan S. Atkinson
11   Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Christoph F. Dietrich
 1   Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
14   Ultrasound Department of the First Affiliated Hospital of Zhengzhou, Zhengzhou University, China
› Author Affiliations
Further Information

Publication History

submitted 27 September 2017

accepted after revision 19 February 2018

Publication Date:
24 April 2018 (online)


Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting.

Methods Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection.

Results 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of lesions were stiffer than the surrounding pancreatic parenchyma (stiff lesions) and 50 % were less stiff or of similar stiffness (soft lesions). High stiffness of the lesion had a sensitivity of 84 % (95 % confidence interval 73 % – 91 %), specificity of 67 % (58 % – 74 %), positive predictive value (PPV) of 56 % (50 % – 62 %), and negative predictive value (NPV) of 89 % (83 % – 93 %) for the diagnosis of malignancy. For the diagnosis of pancreatic ductal adenocarcinoma, the sensitivity, specificity, PPV, and NPV were 96 % (87 % – 100 %), 64 % (56 % – 71 %), 45 % (40 % – 50 %), and 98 % (93 % – 100 %), respectively.

Conclusions In patients with small solid pancreatic lesions, EUS elastography can rule out malignancy with a high level of certainty if the lesion appears soft. A stiff lesion can be either benign or malignant.

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